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Individual

MR. BRIAN RUSS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, LPC

Contact information

Practice address
1049 E NEWELL ST, WHITE CLOUD, MI 49349-8795
(231) 689-7330
Mailing address
1049 E NEWELL ST, P.O. BOX 867, WHITE CLOUD, MI 49349-8795
(231) 689-7330

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6401008789
MI
101YP2500X
Professional Counselor
Primary
6401008789
MI
251B00000X
Case Management Agency
6401008789
MI
251S00000X
Community/Behavioral Health Agency
6401008789
MI

Other

Enumeration date
11/07/2013
Last updated
11/07/2013
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