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Lisa Marie Russow
Mental Health Counselor in Centralia, Illinois
NPI 1487087680

Lisa Marie Russow is a Mental Health Counselor based in Centralia, IL and is specialized in Mental Health. Lisa Marie Russow practices in Centralia, IL. The NPI Number for Lisa Marie Russow is 1487087680 and holds a License No. (Illinois).

The current practice location address for Lisa Marie Russow is 904 M L King Dr, Centralia, IL and can be reached out via phone at 618-533-1391. You can also correspond with Lisa Marie Russow through the mailing address at 904 M L KING DR, CENTRALIA, IL - 62801-3058 (mailing address contact number: 618-533-1391).

Location: 904 M L King Dr, Centralia, IL, 62801-3058
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1487087680
Provider Name
Lisa Marie Russow
Credential
Provider Entity Type
Individual
Gender
Female
Address
904 M L King Dr, Centralia, IL, 62801-3058
Phone Number
618-533-1391
Fax Number
Provider Enumeration Date
08/12/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
904 M L King Dr
City
Centralia
State
Illinois
Zip
62801-3058
Phone Number
618-533-1391
Fax Number
person
Provider Business Mailing Address Details
Address
904 M L King Dr
City
Centralia
State
Illinois
Zip
62801-3058
Phone Number
618-533-1391
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
()
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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