Thomas Russell II

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

76881 Issued in CA

Practice address

3780 Kilroy Airport Way
Long Beach, CA 90806-2457

Phone

(562) 424-6015

Fax

(562) 988-6897

NPI assigned

Aug 27, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1639579675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15281 DEERWOOD LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923360774",
            "telephone_number": "909-899-6095",
            "fax_number": "909-899-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 KILROY AIRPORT WAY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062457",
            "telephone_number": "562-424-6015",
            "fax_number": "562-988-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "THOMAS",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-27",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "94020370",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "94020370",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "101067938",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "76881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kenneth Russell, PH.D.
• Judith Russell, MFT
• Laura A. Russell, M.D.
• Robb Russell, D.C.
• Terry Russell
• Trevor William Russell
• Tylore Russell
• Audrey Russo, R.N.
• Leonard Ross Russo, DDS
• Sandra Geraldine Russo, RD

• Marriage & Family Therapist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; 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.