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Organization
MAXINE RUSSELL PHD LLC
Active
Organization
MAXINE RUSSELL PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAXINE M. RUSSELL PH.D. (MENTAL HEALTH COUNSELOR)
(239) 591-6636
Entity
Organization
Contact information
Practice address
1415 PANTHER LN, SUITE 216, NAPLES, FL 34109-7874
(239) 591-6636
(239) 591-6637
Mailing address
1415 PANTHER LN, SUITE 216, NAPLES, FL 34109-7874
(239) 591-6636
(239) 591-6637
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH4166
FL
Other
Enumeration date
11/16/2008
Last updated
11/16/2008
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