Provider Demographics
NPI:1336589803
Name:RUSSELL, PATRICE NICOLE (BS, MS)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:NICOLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5807
Mailing Address - Country:US
Mailing Address - Phone:405-613-7511
Mailing Address - Fax:
Practice Address - Street 1:1221 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-5807
Practice Address - Country:US
Practice Address - Phone:405-613-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health