Provider Demographics
NPI:1285216747
Name:RUSSELL, LERIN BLACKMON (LPC ASSOCIATE)
Entity type:Individual
Prefix:MRS
First Name:LERIN
Middle Name:BLACKMON
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 FM 698
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-4451
Mailing Address - Country:US
Mailing Address - Phone:936-552-9482
Mailing Address - Fax:
Practice Address - Street 1:105 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-3077
Practice Address - Country:US
Practice Address - Phone:936-899-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health