Individual
MYRNA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
855 CENTRAL DR, SUITE 15, ODESSA, TX 79761-4200
(432) 557-5759
Mailing address
109 THORNRIDGE DR, MIDLAND, TX 79703-6019
(432) 557-5957
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10868
TX
Other
Enumeration date
03/30/2012
Last updated
03/30/2012
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