Individual
KENDRA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
436 COURT ST STE B, MUSKOGEE, OK 74401-6303
(918) 310-0000
Mailing address
109641 S 4157 RD, CHECOTAH, OK 74426-2375
(918) 843-2857
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
174400000X
Specialist
—
—
Other
Enumeration date
04/25/2025
Last updated
04/25/2025
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