Mary Russell, MSW, LADACII

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LDC0000000502 Issued in TN

Practice address

110 McCowat St
Jackson, TN 38301-5279

Phone

(731) 427-7238

NPI assigned

Feb 5, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• T.a.M.B. of Jackson TN Inc

  • Substance Abuse Rehabilitation Facility
  • Jackson, TN
  • NPI 1629232384
  NPD (past)

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1508321423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MCCOWAT ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015279",
            "telephone_number": "731-427-7238",
            "fax_number": "731-423-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MCCOWAT ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015279",
            "telephone_number": "731-427-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARY",
        "credential": "MSW, LADACII",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TN",
            "license": "LDC0000000502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Ross, MD
• Alan C Rothrock, MD
• Candace Mayberry Rowland, A.P.N.
• Ryan Allen Roy, MD
• Amor J Royer, MD
• Tina Marie Russell, MSN, APRN, FNP-C
• Melissa N Ryan, DO
• S Joglekar MD Inc
• S2 Inc
• Sa Swallowing Services PLLC

• Addiction (Substance Use Disorder) Counselor in Jackson, TN
• Providers in Jackson, TN by specialty
• Addiction (Substance Use Disorder) Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; 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.