Individual
CHARLES EDWARD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
1644 S COLLEGE AVE, FORT COLLINS, CO 80525-1007
(970) 221-0999
(970) 221-0999
Mailing address
2221 A STREET RD, GREELEY, CO 80631-1747
(970) 566-0510
(970) 221-2727
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 4285
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31800335
—
CO
Enumeration date
05/09/2007
Last updated
07/08/2007
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