Miranda C Russell, LMHSP, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2347 Issued in TN

Practice address

105 Rowdy Row
Bean Station, TN 37708

Phone

(865) 767-3074

Fax

(865) 767-3076

NPI assigned

Feb 12, 2010

Last updated

Oct 2, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Tennessee State UniversityGroup PAC ID 2769394774, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Tennessee State University

  dba Johnson City Downtown Clinic Day Center

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1093990608
  Medicare reassignment Care Compare group NPD
• East Tennessee State University

  dba Hancock County Elementary School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Sneedville, TN
  • NPI 1326142563
  NPD

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1346572591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 TREADWAY CIR",
            "city": "THORN HILL",
            "state": "TN",
            "postal_code": "378815039",
            "telephone_number": "423-733-9359",
            "fax_number": "865-767-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ROWDY ROW",
            "city": "BEAN STATION",
            "state": "TN",
            "postal_code": "37708",
            "telephone_number": "865-767-3074",
            "fax_number": "865-767-3076"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Hancock County Elementary School Based Health Center",
            "address_2": "391 Court Street",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378690723",
            "country_code": "US",
            "telephone_number": "423-733-2121",
            "fax_number": "423-733-4563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693041",
            "country_code": "US",
            "telephone_number": "423-733-2819",
            "fax_number": "423-733-8509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MIRANDA",
        "middle_name": "C",
        "credential": "LMHSP, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-12",
        "last_updated": "2024-10-02",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "2347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Michelle Merritt
• Emily Moucha, DPT
• Claude E Moyers
• Lani Rinehardt, OTR/L, OTD
• Courtney Russell
• Latasha M Seal, NP
• Amanullah Siddiqi, M.D.
• Jaime Skeen
• Alexis Faith Smith
• Southern Care Clinic LLC

• Mental Health Counselor in Bean Station, TN
• Providers in Bean Station, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.