Individual
MS. KELLY LEONORA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT, CDPT
Contact information
Practice address
611 12TH AVE S, SEATTLE, WA 98144-2007
(206) 324-9360
Mailing address
611 12TH AVE S, SEATTLE, WA 98144-2007
(206) 324-9360
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60846150
WA
101YM0800X
Mental Health Counselor
LF60294042
WA
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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