Gwendolyn L Smith-Russell, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

423 Issued in WY

Practice address

1613 Evans Ave
Cheyenne, WY 82001-4619

Phone

(307) 221-1133

Fax

(307) 635-3965

NPI assigned

Jun 14, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407974400000",
    "number": "1649474396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 VISTA LN",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093332",
            "telephone_number": "307-221-1133",
            "fax_number": "307-635-3965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 EVANS AVE",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014619",
            "telephone_number": "307-221-1133",
            "fax_number": "307-635-3965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-RUSSELL",
        "first_name": "GWENDOLYN",
        "middle_name": "L",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2014-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WY",
            "license": "147",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smart Sports Medicine Clinic PC
• Smart Sports Medicine LLC
• Edward N Smedley, PHARMD
• Jerrad Barton Smedley, PHARMD
• Smith Psychological Services
• Brian C Smith, D.C.
• Bruce D Smith, MD
• Christian Thomas Smith
• Emily A Smith, BSW, CSW
• Emily D Smith, M.S., R.D.

• Professional Counselor in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Professional Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.