Individual
DR. CARL LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A. DMIN
Contact information
Practice address
2030 MOON ST NE, ALBUQUERQUE, NM 87112-2709
(505) 298-7620
Mailing address
2030 MOON ST NE, ALBUQUERQUE, NM 87112-2709
(505) 298-7620
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
T-0177631
NM
Other
Enumeration date
09/30/2015
Last updated
11/17/2015
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