Provider Demographics
NPI:1891905428
Name:NEWTON, RUSSEL MARION II (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:MARION
Last Name:NEWTON
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1715 W WORLEY ST
Mailing Address - Street 2:STE.A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1015
Mailing Address - Country:US
Mailing Address - Phone:573-446-1614
Mailing Address - Fax:573-446-8532
Practice Address - Street 1:1715W.WORLEY ST.
Practice Address - Street 2:STE.A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-446-1614
Practice Address - Fax:573-446-8532
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO00828103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist