Individual
EBBIE RUSSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMHC
Contact information
Practice address
1785 E 1450 S STE 300, CLEARFIELD, UT 84015-2299
(888) 949-4864
Mailing address
4460 S HIGHLAND DR STE 210, SALT LAKE CITY, UT 84124-3550
(888) 949-4864
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
9149805-6004
UT
Other
Enumeration date
09/03/2013
Last updated
06/12/2020
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