Provider Demographics
NPI:1669917944
Name:RUSSELL, BRANDI (LPC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0014
Mailing Address - Country:US
Mailing Address - Phone:903-737-2475
Mailing Address - Fax:903-737-2479
Practice Address - Street 1:2870 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9357
Practice Address - Country:US
Practice Address - Phone:903-737-2475
Practice Address - Fax:903-737-2479
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional