Individual
CATHERINE PHYLLIS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
Mailing address
1333 IRIS AVE, BOULDER, CO 80304-2226
(303) 443-8500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437544962
—
CO
Enumeration date
04/01/2015
Last updated
06/20/2016
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