Provider Demographics
NPI:1326766700
Name:RUSSELL, JESSICA DAWN (CHT, MA, NBC-HWC,)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CHT, MA, NBC-HWC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4805
Mailing Address - Country:US
Mailing Address - Phone:310-801-6211
Mailing Address - Fax:
Practice Address - Street 1:300 S BEVERLY DR STE 203
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4805
Practice Address - Country:US
Practice Address - Phone:310-801-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty