Provider Demographics
NPI:1760542534
Name:RUSSELL, JEMIE B (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JEMIE
Middle Name:B
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 66TH ST
Mailing Address - Street 2:STE 6
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2352
Mailing Address - Country:US
Mailing Address - Phone:727-743-8446
Mailing Address - Fax:727-577-3792
Practice Address - Street 1:10707 66TH ST
Practice Address - Street 2:STE 6
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2352
Practice Address - Country:US
Practice Address - Phone:727-743-8446
Practice Address - Fax:727-577-3792
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health