Individual
JAI KIERON RENE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2135 CHARLOTTE ST STE 2, BOZEMAN, MT 59718-2741
(206) 930-8970
Mailing address
PO BOX 385, BOZEMAN, MT 59771-0385
(206) 930-8970
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-38038
MT
Other
Enumeration date
06/07/2019
Last updated
12/08/2021
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