Individual provider Active NPI

Christina Russell, BS, MA STUDENT

  • Counselor
  • Peru, IN
National Provider Identifier
1750921938
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
1000 N Broadway Ste a
Peru, IN 46970
NPI assigned
Jan 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

1000 N Broadway Ste a
Peru, IN 46970

Mailing address

1015 Michigan Ave
Logansport, IN 46947-1526
Phone (574) 722-5151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250102002283 IN Practitioner - Mental Health Counselor 9537696570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Four County Comprehensive Mental Health Center IncGroup PAC ID 2163334277, 42 clinicians

Practice addresses (Care Compare)

1000 N Broadway
Peru, IN 46970-1070
Phone (574) 722-5151

1015 Michigan Ave
Logansport, IN 46947-1526
Phone (574) 722-5151

1948 W Boulevard
4C Health
Kokomo, IN 46902-6078
Phone (574) 722-5151

800 Fulton St
Logansport, IN 46947-1577
Phone (574) 722-5151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Four County Comprehensive Mental Health Center, Inc CurrentSince Dec 2, 2024 Accepting new patients
Four County Comprehensive Mental Health Center Inc CurrentSince Dec 2, 2024 Accepting new patients

Locations

3002 E Wabash St
Frankfort, IN 46041

2796 N Apperson Way
Kokomo, IN 46901

1948 W Boulevard
Kokomo, IN 46902
Phone (765) 236-1290

1 Landis Ln
Logansport, IN 46947

1015 Michigan Ave
Logansport, IN 46947

421 12th St
Logansport, IN 46947
Phone (574) 722-7407

800 Fulton St
Logansport, IN 46947
Phone (574) 205-2600

1000 N Broadway
#A
Peru, IN 46970
Phone (765) 472-1931

2355 S Business 31
Peru, IN 46970

1000 N Broadway
Peru, IN 46970
Phone (765) 472-5335

401 E 8th St
Rochester, IN 46975
Phone (574) 223-8565

1 Zebra Ln
Rochester, IN 46975
Phone (574) 223-2159

417 S Chicago St
Royal Center, IN 46978

619 S Main St
Tipton, IN 46072

1060 S Main St
Tipton, IN 46072
Phone (765) 675-1111

2418 Curtis Dr
Winamac, IN 46996
Phone (219) 946-7710

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1750921938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N BROADWAY STE A",
            "city": "PERU",
            "state": "IN",
            "postal_code": "46970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CHRISTINA",
        "credential": "BS, MA STUDENT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IN

Sources for this page

Verify at the official NPI Registry.