Provider Demographics
NPI:1841336575
Name:SPRAGUE, RUSSELL LLOYD (MFT)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LLOYD
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10698 ARBORETUM PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-566-1808
Mailing Address - Fax:
Practice Address - Street 1:41002 COUNTY CENTER DRIVE
Practice Address - Street 2:SUITE #320
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-600-6383
Practice Address - Fax:951-600-6365
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist