Active NPI
Jennifer Rette Russell, LPC, RPT
- Mental Health Counselor
- Addison, TX
National Provider Identifier
1366875015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 71168
- Practice address
- 14673 Midway Rd
Suite 211
Addison, TX 75001-7500 - Phone
- (469) 708-7650
- NPI assigned
- Aug 16, 2013
- Last updated
- Aug 31, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 71168 | TX | Primary |
Addresses
Primary practice location
14673 Midway Rd
Suite 211
Addison, TX 75001-7500
Mailing address
512 Cap Rock Dr Ste 211
Richardson, TX 75080-2306
Phone (469) 708-7650
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71168 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598832000000",
"number": "1366875015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 CAP ROCK DR STE 211",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750802306",
"telephone_number": "469-708-7650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14673 MIDWAY RD",
"address_2": "SUITE 211",
"city": "ADDISON",
"state": "TX",
"postal_code": "750017500",
"telephone_number": "469-708-7650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "JENNIFER",
"middle_name": "RETTE",
"name_prefix": "Mrs.",
"credential": "LPC, RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-16",
"last_updated": "2020-08-31",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "71168",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Addison, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.