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Individual
MRS. PAMELA ANNE RUSSELL
Active
Individual
MRS. PAMELA ANNE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LPC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00570
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00S76J
BLUE CROSS BLUE SHIELD
TX
05
—
108265302
—
TX
Enumeration date
06/08/2005
Last updated
10/06/2011
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