Individual
CHARLES R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT-17-35016
Contact information
Practice address
4520 S HURON ST, ENGLEWOOD, CO 80110-5636
(720) 435-0048
Mailing address
4520 S HURON ST, ENGLEWOOD, CO 80110-5636
(720) 435-0048
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-35016
CO
Other
Enumeration date
05/10/2018
Last updated
05/10/2018
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