Russell, John Kenneth

Russell, John Kenneth is an sole proprietor health care provider with primary practice located at 1945 Palo Verde Ave Suite 202, Long Beach CA 90815-3443. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Russell, John Kenneth can be contacted via phone (562) 799-3333.

Contact Information

Primary practice address
1945 Palo Verde Ave Suite 202 Long Beach CA 90815-3443
Phone: (562) 799-3333
Fax: (562) 799-3355
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY4430 California

Profile Details

NPI number 1407843295
LBN Legal business name Russell, John Kenneth
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 5th, 2005
Last updated Apr 17th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407843295 NPPES
California Other 95-3278711 FEDERAL TAX ID

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