Individual
DR. JIM RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
777 CRAIG RD STE 200, SAINT LOUIS, MO 63141-7190
(314) 963-8862
(314) 918-8943
Mailing address
777 CRAIG RD STE 200, SAINT LOUIS, MO 63141-7190
(314) 963-8862
(314) 918-8943
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001736
MO
Other
Enumeration date
02/10/2008
Last updated
10/22/2016
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