Provider Demographics
NPI:1346482346
Name:RUSSELL, TERRI RENEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:RENEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S EWING ST
Mailing Address - Street 2:424
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5938
Mailing Address - Country:US
Mailing Address - Phone:406-431-1232
Mailing Address - Fax:
Practice Address - Street 1:25 S EWING ST
Practice Address - Street 2:424
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5938
Practice Address - Country:US
Practice Address - Phone:406-431-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1231101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)