Individual
JENNIFER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC-INTERN
Contact information
Practice address
700 HEMPHILL ST STE A, FORT WORTH, TX 76104-3105
(817) 334-0111
Mailing address
700 HEMPHILL ST STE A, FORT WORTH, TX 76104-3105
(817) 334-0111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
57705
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
03/28/2022
Last updated
07/19/2023
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