Individual
MR. MARK RUSSELL IRELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LMAC
Contact information
Practice address
909 S 2ND ST, HIAWATHA, KS 66434-2774
(785) 742-7113
Mailing address
909 S 2ND ST, HIAWATHA, KS 66434-2774
(785) 742-7113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2112
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841281805
—
KS
Enumeration date
06/25/2009
Last updated
04/10/2019
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