| Russell Psychiatry, Professional Limited Liability Company | |
|
2006 S Loop 336 W Ste 500 Conroe TX 77304-3315 | |
| (817) 726-9444 | |
| Not Available |
| Full Name | Russell Psychiatry, Professional Limited Liability Company |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2006 S Loop 336 W Ste 500, Conroe, Texas |
| Authorized Official Name and Position | Stacey Russell (MANAGER/LEAD PSYCHIATRIST) |
| Authorized Official Contact | 8177269444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Psychiatry, Professional Limited Liability Company 2006 S Loop 336 W Ste 500 Conroe TX 77304-3315 Ph: () - | Russell Psychiatry, Professional Limited Liability Company 2006 S Loop 336 W Ste 500 Conroe TX 77304-3315 Ph: (817) 726-9444 |
| NPI Number | 1356846729 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 03/28/2018 |
| Medicare PECOS PAC ID | 8123376977 |
|---|---|
| Medicare Enrollment ID | O20180810000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356846729 | NPI | - | NPPES |
| 1275945511 | Other | TX | NPI DR. STACEY RUSSELL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | Q6697 (Texas) | Primary |
| Provider Name | Stacey J Russell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275945511 PECOS PAC ID: 4981952405 Enrollment ID: I20180731002345 |
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