Provider Demographics
NPI:1871887372
Name:RUSSELL, PAUL A (LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:RUSSELL
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 W PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-9338
Mailing Address - Country:US
Mailing Address - Phone:616-215-2231
Mailing Address - Fax:
Practice Address - Street 1:4236 W PHELPS RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-9338
Practice Address - Country:US
Practice Address - Phone:616-215-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health