Provider Demographics
NPI:1538277322
Name:POPE, RUSSELL (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:POPE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 109TH ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3754
Mailing Address - Country:US
Mailing Address - Phone:262-278-0238
Mailing Address - Fax:
Practice Address - Street 1:830 N 109TH ST
Practice Address - Street 2:SUITE 26
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3754
Practice Address - Country:US
Practice Address - Phone:262-278-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3634-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional