Provider Demographics
NPI:1821762469
Name:RUSSELL, DAVID F (CP 60455259)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:F
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:CP 60455259
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2220
Mailing Address - Country:US
Mailing Address - Phone:509-532-8855
Mailing Address - Fax:509-532-8844
Practice Address - Street 1:140 S ARTHUR ST STE 400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2220
Practice Address - Country:US
Practice Address - Phone:509-532-8855
Practice Address - Fax:509-532-8844
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60455259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty