Individual
MIRANDA C RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHSP, LPC
Contact information
Practice address
105 ROWDY ROW, BEAN STATION, TN 37708
(865) 767-3074
(865) 767-3076
Mailing address
438 TREADWAY CIR, THORN HILL, TN 37881-5039
(423) 733-9359
(865) 767-3076
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2347
TN
Other
Enumeration date
02/12/2010
Last updated
10/02/2024
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