Active NPI
Heather Ann Russell, PSYD
- Clinical Psychologist
- Anchorage, AK
National Provider Identifier
1932352275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 581
- Practice address
- 4155 Tudor Centre Dr
Suite #103
Anchorage, AK 99508-5902 - Phone
- (907) 729-8624
- NPI assigned
- Oct 30, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 581 | AK | Primary |
Addresses
Primary practice location
4155 Tudor Centre Dr
Suite #103
Anchorage, AK 99508-5902
Mailing address
4201 Tudor Centre Dr
Suite #320
Anchorage, AK 99508-5904
Phone (907) 729-8624
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS2781 | Medicaid | AK |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 581 | AK | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southcentral Foundation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba 1115-Rural Behavioral Health
- Community/Behavioral Health Agency
- Anchorage, AK
- NPI 1639722069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1932352275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 TUDOR CENTRE DR",
"address_2": "SUITE #320",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085904",
"telephone_number": "907-729-8624",
"fax_number": "907-729-8607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4155 TUDOR CENTRE DR",
"address_2": "SUITE #103",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085902",
"telephone_number": "907-729-8624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "HEATHER",
"middle_name": "ANN",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-30",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AK",
"license": "581",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS2781",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.