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Individual
DR. JOHN KENNETH RUSSELL
Active
Individual
DR. JOHN KENNETH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY4430
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-3278711
FEDERAL TAX ID
CA
Enumeration date
10/05/2005
Last updated
04/17/2014
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