Individual
RUSSELL APPLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1121 N OLIVE AVE, CASA GRANDE, AZ 85122-3418
(602) 618-3756
Mailing address
4726 E WHITE ASTER ST, PHOENIX, AZ 85044-4908
(602) 618-3756
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BH7438
AZ
101YP2500X
Professional Counselor
BH7438
AZ
1041C0700X
Clinical Social Worker
BH7438
AZ
261QM0850X
Adult Mental Health Clinic/Center
BH7438
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH7438
AZ
323P00000X
Psychiatric Residential Treatment Facility
BH7438
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7438
DHS - LICENSE FOR BHRF
AZ
Enumeration date
05/06/2022
Last updated
06/19/2024
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