Provider Demographics
NPI:1417560806
Name:PRAUSE, RUSSELL (MS, LPC-S)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:PRAUSE
Suffix:
Gender:M
Credentials:MS, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12268 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8097
Mailing Address - Country:US
Mailing Address - Phone:623-888-4310
Mailing Address - Fax:
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2703
Practice Address - Country:US
Practice Address - Phone:623-888-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2501015101YM0800X
AZ20565101YM0800X
AZLPC-20565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health