Wilburn Russell Jr., LPC
Counselor, Professional in Springfield, MO. Individual provider (NPI-1).
NPI number1336733971
StatusActive
Last updated in NPPESFeb 24, 2021
Details
- NPI
- 1336733971
- Entity type
- Individual (NPI-1)
- Name
- Wilburn Russell Jr.
- Credential
- LPC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 24, 2021
- Certification date
- Feb 24, 2021
- Last updated
- Feb 24, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 001677 | MO | Yes |
Practice location
636 W Republic Rd Ste G100Springfield, MO 65807-5811
Phone 417-862-8282 · Fax 417-862-8805
Mailing address
636 W Republic Rd Ste G100Springfield, MO 65807-5811
Phone 417-862-8282 · Fax 417-862-8805
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