Russell, Michael

Russell, Michael is an sole proprietor health care provider with primary practice located at 207 Rock Prairie Rd Suite B, College Station TX 77845-8777. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Russell, Michael can be contacted via phone (979) 693-3393.

Contact Information

Primary practice address
207 Rock Prairie Rd Suite B College Station TX 77845-8777
Phone: (979) 693-3393
Fax: (979) 694-7337
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 9957 Texas

Profile Details

NPI number 1285640128
LBN Legal business name Russell, Michael
Credentials M.A., D.MIN.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 31st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285640128 NPPES
Texas Other 2809LC BCBS

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