Russell, Panola E.

Russell, Panola E. is an sole proprietor health care provider with primary practice located at 855 Burnham Dr Apt F , University Park IL 60484-3042. She recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Russell, Panola E. can be contacted via phone (708) 534-7559.

Contact Information

Primary practice address
855 Burnham Dr Apt F University Park IL 60484-3042
Phone: (708) 534-7559
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 87001334A Indiana

Profile Details

NPI number 1336479542
LBN Legal business name Russell, Panola E.
Credentials LCPC CCBT LCAC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 11th, 2010
Last updated May 25th, 2012 - about 14 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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