Provider Demographics
NPI:1932931094
Name:RUSSELL, ROBERT CARL (MMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARL
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2512
Mailing Address - Country:US
Mailing Address - Phone:615-785-5832
Mailing Address - Fax:
Practice Address - Street 1:377 RIVERSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5393
Practice Address - Country:US
Practice Address - Phone:615-785-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional