Individual
ROBERT BERNARD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 S 400 E, ST GEORGE, UT 84770-3700
(435) 656-8918
Mailing address
99 W 300 S, ST GEORGE, UT 84770-3519
(435) 705-0792
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11577525-6018
UT
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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