Provider Demographics
NPI:1053187864
Name:FRENCH, RUSSELL W (PSYD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:W
Last Name:FRENCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E CLARK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5145
Mailing Address - Country:US
Mailing Address - Phone:805-448-7469
Mailing Address - Fax:805-354-0806
Practice Address - Street 1:1103 E CLARK AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5145
Practice Address - Country:US
Practice Address - Phone:805-448-7469
Practice Address - Fax:805-354-0806
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical