MR. Jacob G Russell, LAC

NPI #1184799876 in Melbourne, Arkansas

Provider Information

NPI Number: 1184799876
Entity Type: Individual
Name: MR. Jacob G Russell, LAC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Professional
Credential: LAC
Enumeration Date: Nov 21, 2006
Last Updated: Jan 20, 2011

Practice Location

Address: 104 CONNIEBROOK LN
City: Melbourne
State: Arkansas
ZIP Code: 72556-8861
Phone: (870) 258-3305

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X
Counselor - Professional — Professional	101YP2500X	Primary

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