Provider Demographics
NPI:1326288440
Name:RUSSELL, DANIEL RAY (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 DR MARTIN LUTHER KING JR DR W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2816
Mailing Address - Country:US
Mailing Address - Phone:662-323-5588
Mailing Address - Fax:662-323-5588
Practice Address - Street 1:519 DR MARTIN LUTHER KING JR DR W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2816
Practice Address - Country:US
Practice Address - Phone:662-323-5588
Practice Address - Fax:662-323-5588
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional