Russell, Tamika D

Russell, Tamika D is an sole proprietor health care provider with primary practice located at 938 Marisa Ln , Desoto TX 75115-3880. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Agencies / Community/Behavioral Health. Agencies / Community/Behavioral Health is her primary health care specialty. Russell, Tamika D can be contacted via phone (214) 799-0045.

Contact Information

Primary practice address
938 Marisa Ln Desoto TX 75115-3880
Phone: (214) 799-0045
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 81523 Texas
Agencies / Community/Behavioral Health 251S00000X 81523 Texas

Profile Details

NPI number 1427659853
LBN Legal business name Russell, Tamika D
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 3rd, 2020
Last updated Feb 18th, 2021 - about 5 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 1427659853 NPPES
Texas MEDICAID 418990401
Texas MEDICAID 4056772

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