Provider Demographics
NPI:1700114113
Name:RUSSELL, B ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:ANNE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-2400
Mailing Address - Country:US
Mailing Address - Phone:520-325-6797
Mailing Address - Fax:
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 380
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3828
Practice Address - Country:US
Practice Address - Phone:520-219-8690
Practice Address - Fax:520-219-8694
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling