Maxine Russell PHD LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH4166 Issued in FL

Legal business name

MAXINE RUSSELL PHD LLC

Practice address

1415 Panther LN
Suite 216
Naples, FL 34109-7874

Phone

(239) 591-6636

Fax

(239) 591-6637

NPI assigned

Nov 16, 2008

Last updated

Nov 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Maxine M. Russell, PH.D.

Title

Mental Health Counselor

Phone

(239) 591-6636

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1226793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226793600000",
    "number": "1720232804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PANTHER LN",
            "address_2": "SUITE 216",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341097874",
            "telephone_number": "239-591-6636",
            "fax_number": "239-591-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PANTHER LN",
            "address_2": "SUITE 216",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341097874",
            "telephone_number": "239-591-6636",
            "fax_number": "239-591-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXINE RUSSELL PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-16",
        "last_updated": "2008-11-16",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "MAXINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "239-591-6636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH4166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Naples, FL
• Providers in Naples, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2008; 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.