Individual
CARESSA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1511
(918) 542-7374
Mailing address
22 N EIGHT TRIBES TRL, MIAMI, OK 74354-1011
(918) 387-8720
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7359-P
OK
Other
Enumeration date
07/08/2020
Last updated
08/23/2021
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