Individual
ELYSIA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
313 W APACHE ST, FARMINGTON, NM 87401-5835
(505) 325-5321
Mailing address
313 W APACHE ST, FARMINGTON, NM 87401-5835
(505) 325-5321
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
13375769-3501
UT
1041C0700X
Clinical Social Worker
CSW.09929906
CO
1041C0700X
Clinical Social Worker
Primary
SWB-2023-1117
NM
Other
Enumeration date
10/18/2021
Last updated
03/31/2025
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