Active NPI
Kevin Patrick Russell, MA, LPC
- Professional Counselor
- Ambler, PA
National Provider Identifier
1174339683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC004191
- Practice address
- 85 Lemon St
Ambler, PA 19002-4812 - Phone
- (445) 255-1379
- NPI assigned
- Dec 9, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC01083300 | NJ | |
| Professional Counselor | 101YP2500X | PC004191 | PA | Primary |
Addresses
Primary practice location
85 Lemon St
Ambler, PA 19002-4812
Mailing address
85 Lemon St
Ambler, PA 19002-4812
Phone (445) 255-1379
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 |
|---|---|---|---|
| 37PC01083300 | NJ | MD | Professional Counselor |
| PC004191 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733702400000",
"number": "1174339683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 LEMON ST",
"city": "AMBLER",
"state": "PA",
"postal_code": "190024812",
"telephone_number": "445-255-1379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 LEMON ST",
"city": "AMBLER",
"state": "PA",
"postal_code": "190024812",
"telephone_number": "445-255-1379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "KEVIN",
"middle_name": "PATRICK",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-09",
"last_updated": "2024-12-09",
"certification_date": "2024-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC01083300",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC004191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ambler, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.