Provider Demographics
NPI:1568517175
Name:RUSSELL, TOBI YVETTE (LPC, LLP)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:YVETTE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HAMPTON CIR STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4113
Mailing Address - Country:US
Mailing Address - Phone:248-266-6166
Mailing Address - Fax:248-841-4714
Practice Address - Street 1:130 HAMPTON CIR STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4113
Practice Address - Country:US
Practice Address - Phone:248-266-6166
Practice Address - Fax:248-841-4714
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012174103T00000X
MI6401010934101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1882825Medicaid