Provider Demographics
NPI:1518971712
Name:RUSSELL, RHONDA LYNN (MS)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 MATINEE AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0407
Mailing Address - Country:US
Mailing Address - Phone:702-658-3179
Mailing Address - Fax:702-968-5050
Practice Address - Street 1:4000 E CHARLESTON BLVD
Practice Address - Street 2:#B-230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6659
Practice Address - Country:US
Practice Address - Phone:702-968-5000
Practice Address - Fax:702-968-5050
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health