Charles Edward Russell, MA, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC 4285 Issued in CO

Practice address

1644 S College Ave
Fort Collins, CO 80525-1007

Phone

(970) 221-0999

Fax

(970) 221-0999

NPI assigned

May 9, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841404159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 A STREET RD",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806311747",
            "telephone_number": "970-566-0510",
            "fax_number": "970-221-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 S COLLEGE AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251007",
            "telephone_number": "970-221-0999",
            "fax_number": "970-221-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC 4285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31800335",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Rushton, LCSW
• Sarah Elizabeth Rushton, CCC-SLP
• Marykate Rusnak, D.D.S.
• Michael P Rusnak, MD
• Russell Family Clinic, LLC
• Dianne Russell, RMT
• Joshua Russell, D.C.
• Matthew Russell, MA, LPCC
• Natasha Russell
• Savannah Russell, L.AC.

• Mental Health Counselor in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.