Provider Demographics
NPI:1760759450
Name:RUSSO, VALERIE (LPC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALLIANCE FAMILY SERVICES NORTH
Mailing Address - Street 2:608 S DIVISION
Mailing Address - City:SANDPOINT
Mailing Address - State:IDAHO
Mailing Address - Zip Code:83864
Mailing Address - Country:UM
Mailing Address - Phone:208-265-8195
Mailing Address - Fax:208-265-8327
Practice Address - Street 1:317 W 6TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2321
Practice Address - Country:US
Practice Address - Phone:208-882-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 4309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional