| Randolph G. Russ | |
|
8461 Lake Worth Rd Suite 120 Lake Worth FL 33467-2474 | |
| (561) 201-7180 | |
| Not Available |
| Full Name | Randolph G. Russ |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 8461 Lake Worth Rd, Lake Worth, Florida |
| Authorized Official Name and Position | Randolph Graham Russ (PRESIDENT) |
| Authorized Official Contact | 5612017180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph G. Russ 8461 Lake Worth Rd Suite 120 Lake Worth FL 33467 Ph: (561) 201-7180 | Randolph G. Russ 8461 Lake Worth Rd Suite 120 Lake Worth FL 33467-2474 Ph: (561) 201-7180 |
| NPI Number | 1548625007 |
|---|---|
| Provider Enumeration Date | 12/28/2015 |
| Last Update Date | 08/02/2021 |
| Certification Date | 08/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548625007 | NPI | - | NPPES |
| 000094200 | Medicaid | FL | |
| 102043700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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