Individual provider · Type 1 NPI
Tisa Bernally-Russell, BSW, LSAA
Addiction (Substance Use Disorder) Counselor · Farmington, NM
NPI number
1972933844
Active
Practice location
101 W Broadway, Suite D
Farmington, NM 87401-6419
Mailing address
PO Box 3239, 101 W. Broadway, Suite D
Farmington, NM 87499-3239
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 0160331 (NM) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1972933844
Tisa Bernally-Russell, BSW, LSAA's National Provider Identifier is 1972933844, issued on Nov 13, 2013. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Farmington, NM. The record was last updated on Nov 13, 2013.