Provider Demographics
NPI:1659032365
Name:RUSSELL, KELSI GREER (LCPC)
Entity Type:Individual
Prefix:MR
First Name:KELSI
Middle Name:GREER
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3020
Mailing Address - Country:US
Mailing Address - Phone:443-955-9990
Mailing Address - Fax:
Practice Address - Street 1:7 BREEZY HILL CT APT I
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4748
Practice Address - Country:US
Practice Address - Phone:443-840-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14740101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor