Individual
KATHLEEN M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
139 WEST LAMAR STREET, JASPER, TX 75951
(409) 384-6829
(409) 384-4770
Mailing address
407 PRIVATE ROAD 5130, WOODVILLE, TX 75979-6734
(409) 382-3120
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
53914
TX
171M00000X
Case Manager/Care Coordinator
53914
TX
Other
Enumeration date
02/05/2013
Last updated
02/25/2014
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