Provider Demographics
NPI:1588967525
Name:RUSSELL, LANETTE KAYE (LPC)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:KAYE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LANETTE
Other - Middle Name:KAYE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6845 S 224TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6606
Mailing Address - Country:US
Mailing Address - Phone:580-541-6377
Mailing Address - Fax:
Practice Address - Street 1:1175 S ASPEN AVE STE C
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4800
Practice Address - Country:US
Practice Address - Phone:580-541-6377
Practice Address - Fax:580-234-8891
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK6015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health