Provider Demographics
NPI:1154879161
Name:RUSSELL, CLAUDE J III
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:J
Last Name:RUSSELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6532
Mailing Address - Country:US
Mailing Address - Phone:318-226-5990
Mailing Address - Fax:
Practice Address - Street 1:1406 HAWN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6532
Practice Address - Country:US
Practice Address - Phone:318-226-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool