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Organization
RANDOLPH G. RUSS
Active
Organization
RANDOLPH G. RUSS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDOLPH GRAHAM RUSS (PRESIDENT)
(561) 201-7180
Entity
Organization
Contact information
Practice address
8461 LAKE WORTH RD, SUITE 120, LAKE WORTH, FL 33467-2474
(561) 201-7180
Mailing address
8461 LAKE WORTH RD, SUITE 120, LAKE WORTH, FL 33467
(561) 201-7180
(561) 839-1802
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000094200
—
FL
05
—
102043700
—
FL
Enumeration date
12/28/2015
Last updated
08/02/2021
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