Provider Demographics
NPI:1720735087
Name:SILVER, RUSSELL JR (LCPC, CRC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:SILVER
Suffix:JR
Gender:M
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5938 COPELAND MILLS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4532
Mailing Address - Country:US
Mailing Address - Phone:317-753-6156
Mailing Address - Fax:
Practice Address - Street 1:5938 COPELAND MILLS DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-4532
Practice Address - Country:US
Practice Address - Phone:317-753-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014313101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor