Individual
DR. DAVID LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
8036 MOORSBRIDGE ROAD, SUITE #2, PORTAGE, MI 49024-4417
(269) 327-1438
(269) 327-6454
Mailing address
PO BOX 2585, PORTAGE, MI 49081-2585
(269) 381-0150
(269) 373-4720
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301006163
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OC910420
BCBS
—
01
—
OC94582
BCBS
—
Enumeration date
09/03/2006
Last updated
02/08/2008
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