Provider Demographics
NPI:1811222862
Name:MUIR, RUSSELL ALAN
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALAN
Last Name:MUIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 CATHEDRAL CT.
Mailing Address - Street 2:#4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-612-6140
Mailing Address - Fax:
Practice Address - Street 1:831 CATHEDRAL CT
Practice Address - Street 2:#4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4483
Practice Address - Country:US
Practice Address - Phone:916-612-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)