Individual
MRS. MELONIA SUE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1400 W INDIANA AVE, ELKHART, IN 46516-2164
(546) 276-3775
Mailing address
PO BOX 462, BREMEN, IN 46506-0462
(574) 276-3775
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001623A
IN
Other
Enumeration date
09/19/2007
Last updated
09/19/2007
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