Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1154879161 |
---|---|
Provider Name | Mr. Claude J Russell III |
First Address | Shreveport, LA 71107-6532 |
Second Address | Shreveport, LA 71107-6532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 19/09/2016 |