Provider Demographics
NPI:1902220056
Name:RUSSELL, MICHELE (LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 US HIGHWAY 68
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9188
Mailing Address - Country:US
Mailing Address - Phone:606-584-7055
Mailing Address - Fax:866-533-4929
Practice Address - Street 1:901 US HIGHWAY 68
Practice Address - Street 2:SUITE 900
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9188
Practice Address - Country:US
Practice Address - Phone:606-584-7055
Practice Address - Fax:866-533-4929
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional