Individual
MATTHEW CHARLES RUSSONIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 S JEFFERSON ST STE 200, SPOKANE, WA 99204-3143
(509) 768-6852
Mailing address
400 S JEFFERSON ST STE 200, SPOKANE, WA 99204-3143
(509) 768-6852
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61220659
WA
106H00000X
Marriage & Family Therapist
Primary
MFTA.MG.61551477
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/17/2021
Last updated
07/15/2024
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