Provider Demographics
NPI:1619550878
Name:RUSSELL, JESSICA ANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7744
Mailing Address - Country:US
Mailing Address - Phone:214-404-3483
Mailing Address - Fax:
Practice Address - Street 1:4506 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7744
Practice Address - Country:US
Practice Address - Phone:214-404-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical