Provider Demographics
NPI:1861209181
Name:PERSHING, RUSSELL ALAN
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALAN
Last Name:PERSHING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S WILCOX ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1960
Mailing Address - Country:US
Mailing Address - Phone:720-307-3010
Mailing Address - Fax:
Practice Address - Street 1:401 S WILCOX ST STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1960
Practice Address - Country:US
Practice Address - Phone:720-307-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health