Courtney Elizabeth Russell, PSYD, BCBA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSYC.00015020 Issued in CO

Practice address

210 Edwards Village Blvd # D208
Edwards, CO 81632-5277

Phone

(970) 446-6481

NPI assigned

Mar 28, 2023

Last updated

Jun 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Aug 12, 2024 through Aug 12, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1114621737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 EDWARDS VILLAGE BLVD # D208",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816325277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 EDWARDS VILLAGE BLVD # D208",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816325277",
            "telephone_number": "970-446-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "COURTNEY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PSYD, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSYC.00015020",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-21-51634",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Rosenberg, RN
• Jonathan Paul Rosman, M.D.
• Hannah Ross, M.S.W.
• RSC Aurora, PLLC (Retina Specialists of Colorado)
• Joshua Steven Rusk, M.D.
• Ryan G Zastrow, DDS, PLLC
• Colleen Rynn, PT, DPT, SCS
• Samaritan Center of the Rockies
• Barry Ira Sandler, DO
• Kristina Sappenfield

• Clinical Psychologist in Edwards, CO
• Providers in Edwards, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.