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1851767974
CLEMENT STREET RUSSELL
LOUISVILLE, KY
NPI
1851767974
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: KY 170475)
Enumeration Date
2015-08-12
Last Update Date
2016-10-04
Business Address
-- CLEMENT STREET RUSSELL Psy.D.
912 LILY CREEK RD #201
LOUISVILLE, KY 40243-2815
Phone number: 502-338-0608
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Mailing Address
-- CLEMENT STREET RUSSELL Psy.D.
912 LILY CREEK RD #201
LOUISVILLE, KY 40243-2815
Phone number: 502-338-0608
Copy
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