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Individual
MRS. AMANDA RUSSELL
Active
Individual
MRS. AMANDA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5922570-3502
UT
1041C0700X
Clinical Social Worker
Primary
5922570-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788007788049
—
UT
Enumeration date
04/19/2006
Last updated
02/25/2022
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