NPI 1003093055

Diane Mary Russell, MS

Practitioner Professional Counselor Ozark, MO

Practice location

Address: 4699 N 21st St, Ozark, MO 65721-7684
Phone: (417) 581-4849
Fax: (417) 581-4839
Mailing address: 1406 S 17th Ave, Ozark, MO 65721-8435

Registered specialties

Professional Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YP2500X Licence 2008001153 (MO)

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Registry record

NPI: 1003093055
Entity type: Individual
Sex (as registered): Female
NPI issued: 22 Jan 2008
Record last updated: 22 Jan 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.