Individual provider · Type 1 NPI

Lisa Marie Russow

Mental Health Counselor · Centralia, IL

NPI number 1487087680 Active

Practice location

904 M L King Dr
Centralia, IL 62801-3058

Call (618) 533-1391 Map

Specialties and licenses

TaxonomyCodeLicense
Counselor 101Y00000XNone listed
Addiction (Substance Use Disorder) Counselor 101YA0400XNone listed
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1487087680

Lisa Marie Russow's National Provider Identifier is 1487087680, issued on Aug 12, 2013. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Centralia, IL. The record was last updated on Aug 12, 2013.