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Organization
RUSSOM RECOVERY THERAPIES LLC
Active
Organization
RUSSOM RECOVERY THERAPIES LLC
Active
Other names
LIFE RECOVERY THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH HOUPT (CREDENTIALING)
(517) 676-9797
Entity
Organization
Contact information
Practice address
4519 CASCADE RD SE STE 5, GRAND RAPIDS, MI 49546-8319
(616) 228-2045
Mailing address
PO BOX 10, MASON, MI 48854-0010
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
03/26/2025
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