Provider Information for 1528414489
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BETH RUSSELL LPC
Sex: Female
NPI: 1528414489
Last Updated: 2022-02-04
Certification Date: 2022-02-04
Certification Date: 2022-02-04
Details
| Name | Value | ||||||||
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| NPI | 1528414489 | ||||||||
| Enumeration Date | 2016-05-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 825 ILLINOIS AVE SALIDA, CO 81201-3214 United States Phone: 719-239-1961 | Fax:719-745-7000 | ||||||||
| Primary Practice Address | 910 RUSH DR SALIDA, CO 81201-9665 United States Phone: 719-539-6637 | Fax: | ||||||||
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