Thomas Michael Russell Jr., BA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

5966 Scottsville Rd
Bowling Green, KY 42104-0387

Phone

(270) 904-5104

NPI assigned

May 25, 2022

Sex

Male

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

Other names 1

• Mr. Thomas Michael Russell Jr. Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

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.

• KW Consulting, LLC

  • Mental Health Counselor
  • Bowling Green, KY
  • NPI 1679127781
  NPD

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1467190777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 WESTBROOK RD",
            "city": "ALVATON",
            "state": "KY",
            "postal_code": "421228682",
            "telephone_number": "502-553-5746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5966 SCOTTSVILLE RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421040387",
            "telephone_number": "270-904-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "THOMAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "U8171581502",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tommy.russell@fullerlifecounseling.org",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5966 Scottsville Rd",
            "city": "Bowling Green",
            "state": "KY",
            "country_code": "US",
            "postal_code": "421040387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "RUSSELL",
            "middle_name": "MICHAEL",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "BA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rural Health Initiative, LLC
• Anna Jo Lynn Rush, RBT
• Amaan Rushdi
• Cecilia Russell, RCR
• Holly Russell
• Timothy Glen Russell
• John Anthony Ruth Jr., M.D.
• Karli Rutherford
• Dannae Ryan-Kessler, RBT
• Dorisa Ryherd, LCSW

• Mental Health Counselor in Bowling Green, KY
• Providers in Bowling Green, 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 May 25, 2022; 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.