Individual
CHRISTY MICHELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
719 SPENCER ST, LOGANSPORT, IN 46947-3583
(765) 210-1284
Mailing address
404 W CENTER ST, ROYAL CENTER, IN 46978-8938
(574) 398-8279
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB529930
BEHAVIOR ANALYST CERTIFICATION BOARD
IN
Enumeration date
09/07/2022
Last updated
09/07/2022
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