Provider Demographics
NPI:1265756670
Name:RUSSELL BERRING, JESSICA M (MA, LAC, CFI, CSST)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:RUSSELL BERRING
Suffix:
Gender:F
Credentials:MA, LAC, CFI, CSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 S POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4524
Mailing Address - Country:US
Mailing Address - Phone:303-886-5556
Mailing Address - Fax:
Practice Address - Street 1:1290 S. POTOMAC
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-886-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11977101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor