Individual
JEANNIE L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4436 NW 50TH ST, OKLAHOMA CITY, OK 73112-2212
(405) 858-2700
(405) 858-2810
Mailing address
4436 NW 50TH ST, OKLAHOMA CITY, OK 73112-2212
(405) 858-2700
(405) 858-2810
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
8896
OK
101YM0800X
Mental Health Counselor
Primary
2227
OK
Other
Enumeration date
03/18/2008
Last updated
03/18/2008
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