Provider Demographics
NPI:1649529967
Name:RUSSEY, ANNE NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:NICOLE
Last Name:RUSSEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:NICOLE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 BRANARD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5015
Mailing Address - Country:US
Mailing Address - Phone:713-529-0037
Mailing Address - Fax:713-526-4367
Practice Address - Street 1:401 BRANARD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5015
Practice Address - Country:US
Practice Address - Phone:713-529-0037
Practice Address - Fax:713-526-4367
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional