Provider Demographics
NPI:1528150042
Name:RUSSELL, BARBRA E (MALPC)
Entity type:Individual
Prefix:
First Name:BARBRA
Middle Name:E
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MALPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3196
Mailing Address - Country:US
Mailing Address - Phone:719-562-0108
Mailing Address - Fax:719-562-0129
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3196
Practice Address - Country:US
Practice Address - Phone:719-562-0108
Practice Address - Fax:719-562-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health