Individual
ALLEN FLOYD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4488 BRETON RD SE, GRAND RAPIDS, MI 49508-5270
(616) 340-9026
Mailing address
2529 BRIDGEPORT LN SE, KENTWOOD, MI 49508-8431
(616) 340-9026
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
104100000X
Social Worker
—
—
174200000X
Meals Provider
—
—
225100000X
Physical Therapist
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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