Individual
SARA ANNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5520 E MAIN ST, MESA, AZ 85205-8793
(480) 969-2783
(480) 969-3521
Mailing address
9156 E AVENIDA LAS NOCHES, GOLD CANYON, AZ 85218-4675
(480) 983-9350
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11159
AZ
Other
Enumeration date
05/08/2006
Last updated
07/08/2007
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