Provider Demographics
NPI:1740803683
Name:RYAN RUSS LLC
Entity Type:Organization
Organization Name:RYAN RUSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-256-9791
Mailing Address - Street 1:1900 N BRYANT ST STE 310
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5022
Mailing Address - Country:US
Mailing Address - Phone:501-263-1576
Mailing Address - Fax:
Practice Address - Street 1:1900 N BRYANT ST STE 310
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5022
Practice Address - Country:US
Practice Address - Phone:501-263-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty