Provider Demographics
NPI:1497949333
Name:FLOYD, RUSSELL KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:KEITH
Last Name:FLOYD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-8223
Mailing Address - Country:US
Mailing Address - Phone:785-766-5147
Mailing Address - Fax:
Practice Address - Street 1:700 MASSACHUSETTS ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2344
Practice Address - Country:US
Practice Address - Phone:785-766-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist