Provider Demographics
NPI:1972360980
Name:RUSSONNIK, INNESA (MA, LPC, MFTC)
Entity Type:Individual
Prefix:
First Name:INNESA
Middle Name:
Last Name:RUSSONNIK
Suffix:
Gender:F
Credentials:MA, LPC, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 E ILIFF AVE UNIT 55
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3528
Mailing Address - Country:US
Mailing Address - Phone:720-243-1417
Mailing Address - Fax:
Practice Address - Street 1:12835 E ARAPAHOE RD STE 2-400
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6851
Practice Address - Country:US
Practice Address - Phone:303-954-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional