Individual
MR. JACOB G RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
104 CONNIEBROOK LN, MELBOURNE, AR 72556-8861
(870) 258-3305
(870) 258-3244
Mailing address
PO BOX 97, OXFORD, AR 72565-0097
(870) 258-3305
(870) 258-3244
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A1101009
AR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/21/2006
Last updated
01/20/2011
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