Provider Demographics
NPI:1780082800
Name:RUSSELL, WHITNEY (MA, LPC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 E MOCKINGBIRD LN STE 147
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2672
Mailing Address - Country:US
Mailing Address - Phone:469-626-8116
Mailing Address - Fax:
Practice Address - Street 1:8105 RASOR BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:469-626-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional