Individual
RUSSELL RICHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 DR MICHAEL DEBAKEY DR STE 220, LAKE CHARLES, LA 70601-5888
(337) 478-9331
(337) 478-9828
Mailing address
333 DR MICHAEL DEBAKEY DR STE 220, LAKE CHARLES, LA 70601-5888
(337) 478-9331
(337) 478-9828
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14219
LA
1041C0700X
Clinical Social Worker
29286
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144384801
—
TX
05
—
2443640
—
LA
05
—
3885727
—
LA
Enumeration date
01/16/2007
Last updated
10/25/2022
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