Active NPI
Chanell Russell
- Behavior Technician
- Detroit, MI
National Provider Identifier
1760129811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 7375 Woodward Ave
Suite 2800
Detroit, MI 48202 - Phone
- (855) 568-2492
- NPI assigned
- May 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
7375 Woodward Ave
Suite 2800
Detroit, MI 48202
Mailing address
9618 Beech Daly Rd
Redford, MI 48239-2170
Phone (734) 933-0375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1760129811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9618 BEECH DALY RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482392170",
"telephone_number": "734-933-0375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7375 WOODWARD AVE",
"address_2": "SUITE 2800",
"city": "DETROIT",
"state": "MI",
"postal_code": "48202",
"telephone_number": "855-568-2492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "CHANELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-18",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.