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Mr. Thomas Michael Russell JR., BA
Mental Health Counselor in Bowling Green, Kentucky
NPI 1467190777

Thomas Michael Russell JR. is a Mental Health Counselor based in Alvaton, KY and is specialized in Mental Health. Thomas Michael Russell JR. practices in Bowling Green, KY and has the professional credentials of BA. The NPI Number for Thomas Michael Russell JR. is 1467190777 and holds a License No. (Kentucky).

The current practice location address for Thomas Michael Russell JR. is 5966 Scottsville Rd, Bowling Green, KY and can be reached out via phone at 270-904-5104.

Location: 5966 Scottsville Rd, Bowling Green, KY, 42122-8682
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1467190777
Provider Name
Thomas Michael Russell JR.
Credential
BA
Provider Entity Type
Individual
Gender
Male
Address
5966 Scottsville Rd, Bowling Green, KY, 42122-8682
Phone Number
270-904-5104
Fax Number
Provider Enumeration Date
05/25/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
U8171581502 01 KY CIGNA
institution
Provider Business Practice Location Address Details
Address
5966 Scottsville Rd
City
Bowling Green
State
Kentucky
Zip
42104-0387
Phone Number
270-904-5104
Fax Number
person
Provider Business Mailing Address Details
Address
5966 Scottsville Rd
City
Bowling Green
State
Kentucky
Zip
42104-0387
Phone Number
270-904-5104
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
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Definition
Definition to come...
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