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1417560806
RUSSELL PRAUSE
GLENDALE, AZ
NPI
1417560806
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: AZ LAC-18437)
Enumeration Date
2020-08-26
Last Update Date
2020-08-26
Business Address
RUSSELL PRAUSE MS, LAC
17431 N 71ST DR STE 103
GLENDALE, AZ 85308-8598
Phone number: 602-633-2246
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Mailing Address
RUSSELL PRAUSE MS, LAC
17431 N 71ST DR STE 103
GLENDALE, AZ 85308-8598
Phone number:
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