Individual
CLEMENT STREET RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
912 LILY CREEK RD, #201, LOUISVILLE, KY 40243-2815
(502) 338-0608
(502) 245-1888
Mailing address
912 LILY CREEK RD, #201, LOUISVILLE, KY 40243-2815
(502) 338-0608
(502) 245-1888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
170475
KY
Other
Enumeration date
08/12/2015
Last updated
10/04/2016
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