1578679841 NPI number — JINNA L RUSSELL MS, LPC

Table of content: JINNA L RUSSELL MS, LPC (NPI 1578679841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578679841 NPI number — JINNA L RUSSELL MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
JINNA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578679841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2435 W 44TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80211-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-456-2889
Provider Business Mailing Address Fax Number:
817-516-7019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2435 W 44TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80211-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-456-2889
Provider Business Practice Location Address Fax Number:
817-516-7019
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  14750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 14750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80115001 . This is a "HEALTHSMART PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222604 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3708LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6252509 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1040802 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1077155 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136324 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31623 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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