Mark Charles Russell, PH.D.

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

PY00002607 Issued in WA

Practice address

Usnh Yokosuka Japan
PSC 475 Box 1
Fpo, AP 96350
JP

Phone

(011) 814-6816

NPI assigned

Dec 9, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nilsson Audiology & Hearing Aid Clinic LLC

  • Audiologist-Hearing Aid Fitter
  • Port Orchard, WA
  • NPI 1013286251
  NPD

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1518942770",
    "addresses": [
        {
            "country_code": "JP",
            "country_name": "Japan",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "USNH YOKOSUKA JAPAN",
            "address_2": "PSC 475 BOX 1",
            "city": "FPO",
            "state": "AP",
            "postal_code": "96350",
            "telephone_number": "2534562"
        },
        {
            "country_code": "JP",
            "country_name": "Japan",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "USNH YOKOSUKA JAPAN",
            "address_2": "PSC 475 BOX 1",
            "city": "FPO",
            "state": "AP",
            "postal_code": "96350",
            "telephone_number": "011-814-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARK",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "WA",
            "license": "PY00002607",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "WA",
            "license": "PY00002607",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.