Provider Demographics
NPI:1053881581
Name:RUSSELL, ERIKA L (MS, PLPC)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921A DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2716
Mailing Address - Country:US
Mailing Address - Phone:337-247-6111
Mailing Address - Fax:225-214-1655
Practice Address - Street 1:1921A DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2716
Practice Address - Country:US
Practice Address - Phone:337-247-6111
Practice Address - Fax:225-214-1655
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health