Provider Demographics
NPI:1356708416
Name:RUSSELL, MOREEN (CBHT)
Entity type:Individual
Prefix:
First Name:MOREEN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N DIXIE HWY
Mailing Address - Street 2:101
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-5621
Mailing Address - Country:US
Mailing Address - Phone:954-785-8285
Mailing Address - Fax:954-928-0040
Practice Address - Street 1:817 N DIXIE HWY
Practice Address - Street 2:101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5621
Practice Address - Country:US
Practice Address - Phone:954-785-8285
Practice Address - Fax:954-928-0040
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health