Individual
MR. THOMAS MICHAEL RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
5966 SCOTTSVILLE RD, BOWLING GREEN, KY 42104-0387
(270) 904-5104
Mailing address
211 WESTBROOK RD, ALVATON, KY 42122-8682
(502) 553-5746
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U8171581502
CIGNA
KY
Enumeration date
05/25/2022
Last updated
05/25/2022
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