Provider Demographics
NPI:1578679841
Name:RUSSELL, JINNA L (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JINNA
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1507
Mailing Address - Country:US
Mailing Address - Phone:303-456-2889
Mailing Address - Fax:817-516-7019
Practice Address - Street 1:2435 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1507
Practice Address - Country:US
Practice Address - Phone:303-456-2889
Practice Address - Fax:817-516-7019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14750101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
80115001OtherHEALTHSMART PPO
222604OtherCOMPSYCH
TX3708LCOtherBCBS
6252509OtherUNITED BEHAVIORAL HEALTH
1040802OtherMANAGED HEALTH NETWORK
1077155OtherCIGNA BEHAVIORAL HEALTH
136324OtherVALUE OPTIONS
31623OtherAETNA