Challis Evelyn Russell, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7920 Issued in SC

Practice address

141 McDonald CT
Myrtle Beach, SC 29588-6134

Phone

(843) 294-0646

Fax

(843) 294-0318

NPI assigned

Aug 13, 2021

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Good Vibes Therapy Center, LLC

  • Professional Counselor
  • Myrtle Beach, SC
  • NPI 1720636905
  NPD

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1467127175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 MCDONALD CT",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886134",
            "telephone_number": "843-294-0646",
            "fax_number": "843-294-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 MCDONALD CT",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886134",
            "telephone_number": "843-294-0646",
            "fax_number": "843-294-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CHALLIS",
        "middle_name": "EVELYN",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "7920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC.7920 PC",
            "identifier": "7920",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.goodvibestherapycenter.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Client Portal Login",
            "address_1": "141 McDonald Ct",
            "city": "Myrtle Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295886134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rummel Chiropractic Center, LLC
• Jeannine Rummel, D.C.
• Shannon Rumpf
• Rupa Shetty LLC
• Jan C Rusenko
• Jamie Russell
• Carol K Russo, LMFT
• Brianna Ryan
• Patrick Keith Ryan, D.O.
• Sarah Exum Ryan, PA-C

• Professional Counselor in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.