Individual
JESSICA MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, LAC
Contact information
Practice address
41 MONTEBELLO RD STE LL1, PUEBLO, CO 81001
(719) 545-2746
(719) 542-9638
Mailing address
41 MONTEBELLO RD STE 202, PUEBLO, CO 81001-1366
(719) 545-2746
(719) 542-9638
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD 0000342
CO
101YP2500X
Professional Counselor
Primary
LPC.0011493
CO
Other
Enumeration date
06/14/2011
Last updated
08/24/2018
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