Provider Demographics
NPI:1922230119
Name:RUSSELL-RODRIGUEZ, SENECA
Entity Type:Individual
Prefix:MS
First Name:SENECA
Middle Name:
Last Name:RUSSELL-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SENECA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:608 COLUMBIA HWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1116
Mailing Address - Country:US
Mailing Address - Phone:575-644-8237
Mailing Address - Fax:877-513-3441
Practice Address - Street 1:107 N CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2034
Practice Address - Country:US
Practice Address - Phone:575-644-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0148291101YM0800X
NM0147341101YA0400X
NM0161871101YA0400X
KY17401101YA0400X
NM0168751106H00000X
171M00000X
KY173900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator