Individual
TAMIKA D RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
938 MARISA LN, DESOTO, TX 75115-3880
(214) 799-0045
Mailing address
938 MARISA LN, DESOTO, TX 75115-3880
(214) 799-0045
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
81523
TX
251S00000X
Community/Behavioral Health Agency
Primary
81523
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4056772
—
TX
05
—
418990401
—
TX
Enumeration date
11/03/2020
Last updated
02/18/2021
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