Active NPI
Carl Lee Russell, M.A. DMIN
- Professional Counselor
- Albuquerque, NM
National Provider Identifier
1144690348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- T-0177631
- Practice address
- 2030 Moon St NE
Albuquerque, NM 87112-2709 - Phone
- (505) 298-7620
- NPI assigned
- Sep 30, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | T-0177631 | NM | Primary |
Addresses
Primary practice location
2030 Moon St NE
Albuquerque, NM 87112-2709
Mailing address
2030 Moon St NE
Albuquerque, NM 87112-2709
Phone (505) 298-7620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-0177631 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1144690348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 MOON ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871122709",
"telephone_number": "505-298-7620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 MOON ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871122709",
"telephone_number": "505-298-7620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "CARL",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.A. DMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-30",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "T-0177631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.