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Individual

MICHAEL RUSSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMHC, NCC

Contact information

Practice address
17042 PUNTLEDGE DR, WESTFIELD, IN 46062-6521
(317) 439-9530
Mailing address
17042 PUNTLEDGE DR, WESTFIELD, IN 46062-6521
(317) 439-9530

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003593A
IN

Other

Enumeration date
08/20/2019
Last updated
08/20/2019
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