Individual
BEVERLY JEAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 E MARKET ST STE 1233, INDIANAPOLIS, IN 46204-3250
(317) 455-5307
Mailing address
120 E MARKET ST STE 1233, INDIANAPOLIS, IN 46204-3250
(317) 455-5307
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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