Active NPI
Colleen Russell, LMFT
- Marriage & Family Therapist
- San Anselmo, CA
National Provider Identifier
1396052916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC29249
- Practice address
- 508 San Anselmo Ave
Suite 1B
San Anselmo, CA 94960-2632 - Phone
- (415) 785-3513
- NPI assigned
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC29249 | CA | Primary |
Addresses
Primary practice location
508 San Anselmo Ave
Suite 1B
San Anselmo, CA 94960-2632
Mailing address
PO Box 445
Forest Knolls, CA 94933-0445
Phone (415) 785-3513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC29249 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1396052916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 445",
"city": "FOREST KNOLLS",
"state": "CA",
"postal_code": "949330445",
"telephone_number": "415-785-3513",
"fax_number": "415-594-0857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 SAN ANSELMO AVE",
"address_2": "SUITE 1B",
"city": "SAN ANSELMO",
"state": "CA",
"postal_code": "949602632",
"telephone_number": "415-785-3513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "COLLEEN",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-02",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC29249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Anselmo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.