Mrs Panola E Russell, LCPC CCBT LCAC is a
Behavior Analyst based in University Park, Illinois. Mrs Panola E Russell is licensed to practice in * (Not Available) (license number ) and her current practice location is
855 Burnham Dr Apt F, University Park, Illinois. She can be reached at her office (for appointments etc.) via phone at
(708) 534-7559.
NPI number for Mrs Panola E Russell is 1336479542 and her current mailing address is 855 Burnham Dr Apt F, University Park, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1336479542.
Healthcare Provider's Profile
Full Name | Mrs Panola E Russell |
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Gender | Female |
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Speciality | Behavior Analyst |
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Location | 855 Burnham Dr Apt F, University Park, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1336479542
- Provider Enumeration Date: 01/11/2010
- Last Update Date: 11/03/2024
Medical Identifiers
Medical identifiers for Mrs Panola E Russell such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1336479542 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101Y00000X | Counselor | (* (Not Available)) | Secondary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
101YA0400X | Counselor - Addiction (substance Use Disorder) | 87001334A (Indiana) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Panola E Russell is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mrs Panola E Russell, LCPC CCBT LCAC 855 Burnham Dr Apt F, University Park, IL 60484-3042 Ph: (708) 534-7559 | Mrs Panola E Russell, LCPC CCBT LCAC 855 Burnham Dr Apt F, University Park, IL 60484-3042 Ph: (708) 534-7559 |
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