Individual
MRS. KATHY L RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
907 MARKET ST, DAYTON, TN 37321-1476
(423) 570-7300
Mailing address
375 COUNTRYSIDE DR, EVENSVILLE, TN 37332-5201
(423) 570-8946
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC0000001626
TN
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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