Individual
DR. RUSSELL ELLIS LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1200 VALLEY WEST DR, SUITE 707, WEST DES MOINES, IA 50266-1908
(515) 222-1999
(515) 224-3949
Mailing address
1200 VALLEY WEST DR, SUITE 707, WEST DES MOINES, IA 50266-1908
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
001057
IA
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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