Individual
RICHELE RENE RUSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1501 SAN PEDRO DR NE, ALBUQUERQUE, NM 87110-6731
(505) 823-4530
(505) 823-4538
Mailing address
1501 SAN PEDRO DR NE, ALBUQUERQUE, NM 87110-6731
(505) 823-4530
(505) 823-4538
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-CTL0215911
NM
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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