Provider Demographics
NPI:1710878525
Name:RUSSELL, SARAH (LMFT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:CARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37714-0375
Mailing Address - Country:US
Mailing Address - Phone:423-494-1739
Mailing Address - Fax:
Practice Address - Street 1:1211 BRUCE GAP RD
Practice Address - Street 2:
Practice Address - City:CARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37714-3921
Practice Address - Country:US
Practice Address - Phone:423-494-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist