Individual provider · Type 1 NPI

Jacob G. Russell, LAC

Professional Counselor · Melbourne, AR

NPI number 1184799876 Active

Practice location

104 Conniebrook Ln
Melbourne, AR 72556-8861

Call (870) 258-3305 Map

Fax (870) 258-3244

Mailing address

PO Box 97
Oxford, AR 72565-0097

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XNone listed
Professional Counselor Primary 101YP2500XA1101009 (AR)

Professional Counselor: Definition to come...

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About NPI 1184799876

Jacob G. Russell, LAC's National Provider Identifier is 1184799876, issued on Nov 21, 2006. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Melbourne, AR. The record was last updated on Jan 20, 2011.