Provider Demographics
NPI:1639665896
Name:RUSSELL, PRINCESS HARMONY
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:HARMONY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 E LAKE MEAD BLVD UNIT 208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6995
Mailing Address - Country:US
Mailing Address - Phone:702-418-6110
Mailing Address - Fax:
Practice Address - Street 1:6201 E LAKE MEAD BLVD UNIT 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-6995
Practice Address - Country:US
Practice Address - Phone:702-418-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty