Kelsey Anne Russom, MS

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361007575 Issued in MI

Practice address

30150 Telegraph Rd Ste 245
Bingham Farms, MI 48025-4521

Phone

(231) 580-5845

NPI assigned

Oct 8, 2017

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Flourish Psychological Services PLLC

  • Clinical Psychologist
  • Farmington, MI
  • NPI 1558107730
  NPD Authorized official
• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD (past)

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

{
    "created_epoch": "1507420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1124538848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32040 VALLEY VIEW ST",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363257",
            "telephone_number": "231-580-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30150 TELEGRAPH RD STE 245",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254521",
            "telephone_number": "231-580-5845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32040 Valley View St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MI",
            "postal_code": "483363257",
            "country_code": "US",
            "telephone_number": "231-580-5845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSOM",
        "first_name": "KELSEY",
        "middle_name": "ANNE",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-08",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361007575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delena Lashae Rusan
• Desiray Chante Rush
• Karen R. Russell-Little, M.D.
• Katherine Y Russell, CRNA
• Tanisha Russell Lanette Russell
• Sarah Lynne Ruster
• Kelly Elizabeth Rutter
• S D Consulting Inc
• Jessica Saadeh, DPT
• Enrique Sabbagh, M.D.

• Psychologist in Bingham Farms, MI
• Providers in Bingham Farms, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.