Illyssa Marie Russell, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

167704 Issued in KY

Practice address

1203 American Greeting Card Rd
Corbin, KY 40701-4811

Phone

(606) 528-7010

NPI assigned

Sep 22, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Kentucky Counseling Center, LLC

  • Counselor
  • Louisville, KY
  • NPI 1932590338
  Medicare reassignment NPD
• Cumberland River Behavioral Health, Inc

  • Community/Behavioral Health Agency
  • Corbin, KY
  • NPI 1902023526
  NPD (past)

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1376877407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407020568",
            "telephone_number": "606-528-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 AMERICAN GREETING CARD RD",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407014811",
            "telephone_number": "606-528-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ILLYSSA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-22",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "167704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100413020",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Lynn Ross, BA
• Amanda Helen Rowe, BS
• Lesley Paige Roy
• Rachel Rudder
• Frank Orlando Russell, BS
• Teresa Russell
• Lisa Rutherford
• S. Adam Tackett, DMD, Ms, PLLC
• Saint Joseph Health System, Inc. (Saint Joseph Primary Care Associates Corbin - RHC)
• Saint Joseph Medical Foundation, Inc (Sleep Wellness Center of Corbin)

• Mental Health Counselor in Corbin, KY
• Providers in Corbin, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.