Individual
TERESA MARIE ANTONETTE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
29 417 E HYW 212, BUSBY, MT 59016-0201
(406) 592-3515
Mailing address
PO BOX 201, BUSBY, MT 59016-0201
(406) 592-3515
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
824
MT
Other
Enumeration date
07/10/2008
Last updated
10/26/2015
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