Russow, Lisa Marie

Russow, Lisa Marie is an individual health care provider with primary practice located at 904 M L King Dr , Centralia IL 62801-3058. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Russow, Lisa Marie can be contacted via phone (618) 533-1391.

Contact Information

Primary practice address
904 M L King Dr Centralia IL 62801-3058
Phone: (618) 533-1391
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1487087680
LBN Legal business name Russow, Lisa Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2013
Last updated Aug 12th, 2013 - about 11 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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