Provider Demographics
NPI:1336299288
Name:SCHULTE, RUSSELL WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:SCHULTE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 WAYNELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4044
Mailing Address - Country:US
Mailing Address - Phone:601-842-4385
Mailing Address - Fax:
Practice Address - Street 1:5611 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8929
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:601-420-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional