Provider Demographics
NPI:1376934869
Name:RUSSELL, LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 GATE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-9540
Mailing Address - Country:US
Mailing Address - Phone:606-875-4210
Mailing Address - Fax:606-451-1631
Practice Address - Street 1:3540 S HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3124
Practice Address - Country:US
Practice Address - Phone:606-679-1815
Practice Address - Fax:606-451-1631
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2525581041C0700X
KY4626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health