Provider Demographics
NPI:1740062611
Name:RUSSO, CHRISTIE INEZ (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:INEZ
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2806
Mailing Address - Country:US
Mailing Address - Phone:719-694-6293
Mailing Address - Fax:
Practice Address - Street 1:4975 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5043
Practice Address - Country:US
Practice Address - Phone:719-694-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health