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Individual

MS. CECILIA JO RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSCSW

Contact information

Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-7000
(630) 570-5779
Mailing address
640 HUEBNER, FORT RILEY, KS 66442
(785) 239-7060

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
Primary
1041C0700X
Clinical Social Worker
4201
KS

Other

Enumeration date
02/04/2009
Last updated
09/29/2023
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