Individual
GEORGIA RENEE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6767 W CHARLESTON BLVD STE, LAS VEGAS, NV 89146
(702) 629-7928
Mailing address
6767 W CHARLESTON BLVD, LAS VEGAS, NV 89146-9073
(702) 629-6340
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/19/2013
Last updated
11/19/2013
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