Provider Demographics
NPI:1275995003
Name:SEVILLA, RUSELL V (LPC)
Entity Type:Individual
Prefix:MS
First Name:RUSELL
Middle Name:V
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HARBOR PINES CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5687
Mailing Address - Country:US
Mailing Address - Phone:702-963-6244
Mailing Address - Fax:
Practice Address - Street 1:26 HARBOR PINES CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5687
Practice Address - Country:US
Practice Address - Phone:702-963-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULPC-153101Y00000X
NVCP1171-R101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor