Renee Nicole Russo, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

5360 Holiday Ter Ste 16a
Kalamazoo, MI 49009-2126

Phone

(269) 224-2339

NPI assigned

Sep 13, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 2, 2024 through Oct 2, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wildflower Counseling Services LLC

  • Mental Health Counselor
  • Kalamazoo, MI
  • NPI 1578267290
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1104374776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "NAZARETH",
            "state": "MI",
            "postal_code": "490740334",
            "telephone_number": "269-224-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 HOLIDAY TER STE 16A",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490092126",
            "telephone_number": "269-224-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "RENEE",
        "middle_name": "NICOLE",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-13",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ceirra Alise Russell, LLMSW
• Luke Raymond Russell, DO
• Nicole Russell
• Patricia Ann Russell, RN
• Rebecca Linnea Russell, MD
• Romolo Harris Russo, M.D.
• Rebecca Rustenholtz, LLPC, LLMFT
• Jill B Ruterbusch, PT
• RX Optical Laboratories, Inc
• RX Optical Laboratories, Inc.

• Professional Counselor in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.