Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2141 | OH |
NPI | 1124236302 |
---|---|
Provider Name | Dr. Richard Keith Russell |
First Address | Worthington, OH 43085-2237 |
Second Address | Worthington, OH 43085-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 08/07/2007 |