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Individual

REGINA RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
315 S MAIN AVE, BOLIVAR, MO 65613-2052
(417) 326-2902
(417) 326-4555
Mailing address
315 S MAIN AVE, BOLIVAR, MO 65613-2052
(417) 326-2902
(417) 326-4555

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
004758
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
152040
BLUE CROSS BLUE SHIELD
MO
Enumeration date
01/23/2006
Last updated
07/08/2007
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