Provider Demographics
NPI:1790220184
Name:RUSS, NEONA (LCPC)
Entity Type:Individual
Prefix:
First Name:NEONA
Middle Name:
Last Name:RUSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 NW CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3225
Mailing Address - Country:US
Mailing Address - Phone:913-220-7732
Mailing Address - Fax:
Practice Address - Street 1:5201 JOHNSON DR STE 305
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2920
Practice Address - Country:US
Practice Address - Phone:660-924-2425
Practice Address - Fax:913-229-7511
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2910101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor