CLEMENT STREET RUSSELL (NPI# 1851767974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851767974 |
| Entity Type | Individual |
| Full Name | CLEMENT STREET RUSSELL |
| Credential | PSY.D. |
| Practice Address |
912 Lily Creek Rd #201 Louisville KY 40243-2815 |
| Practice Telephone | 5023380608 |
| Practice Fax Number | 5022451888 |
| Mailing Telephone | 5023380608 |
| Mailing Fax Number | 5022451888 |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2016-10-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
170475 | KY | Behavioral Health & Social Service Providers |
| Street Address |
912 LILY CREEK RD #201 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40243-2815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215586581 | Italy Hester | Behavior Technician | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2019-09-09 |
| 1922654755 | Kristen Maynard | Behavior Technician | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2019-08-16 |
| 1346809449 | Regina Flomo | Behavior Technician | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2019-06-12 |
| 1336702059 | Bailey Selent | Behavior Technician | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2019-04-18 |
| 1689133027 | Cedric Tolliver | Behavior Technician | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2019-03-15 |
| 1649771692 | Amanda Marie Velez | Marriage & Family Therapist | 912 Lily Creek Rd, Louisville, KY 40243 | 2018-02-26 |
| 1821526971 | Cheri Levinson | Psychologist | 912 Lily Creek Rd, Louisville, KY 40243-2815 | 2017-06-01 |
| 1710355722 | Alexandria Pruitt | Psychologist | 912 Lily Creek Rd, Suite 201, Louisville, KY 40243 | 2015-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801949 | Pulsemer Health LLC | Clinic/Center | 11408 Shelbyville Rd, Suite 2, Louisville, KY 40243 | 2020-11-05 |
| 1316563372 | Molly Elizabeth Fitzgerald | Counselor | 350 Evergreen Road Suite 102, Louisville, KY 40243 | 2020-06-24 |
| 1215575410 | Eric Wolfe | Pharmacist | 1320 Snake Foot Drive, Apt 204, Louisville, KY 40243 | 2019-12-18 |
| 1417501974 | Joshua Bynum | Physical Therapist | 12935 Shelbyville Road Ste 106, Louisville, KY 40243 | 2019-08-01 |
| 1376013342 | Carmen Sue Frederick | Psychologist | 731 Speckman Road, Louisville, KY 40243 | 2018-12-03 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1659811636 | Jean Steltenpohl | Dietitian, Registered | 518 Cheskirk Pl, Louisville, KY 40243 | 2017-02-24 |
| 1548555287 | Jonathan D Senters | Pharmacist | 12975 Shelbyville Road, T-2728, Middletown, KY 40243 | 2011-06-10 |
| 1023339835 | Ashley Rose Havens | Speech-Language Pathologist | 11510 Main Street, Louisville, KY 40243 | 2010-06-15 |
| 1801110424 | Shawna L. Kauffman | Family Medicine | 12955 Shelbyville Rd Ste 2, Louisville, KY 40243 | 2010-03-25 |
| Find all providers in zip 40243 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396377164 | Mariya Leyderman | Psychologist | 974 Breckenridge Ln # 171, Louisville, KY 40207-4619 | 2020-02-10 |
| 1841821196 | Sally Losson Brenzel | Psychologist | 10503 Timberwood Cir Ste 205, Louisville, KY 40223-5395 | 2020-01-27 |
| 1013495902 | Melissa Ann Gibson | Psychologist | 6500 Glenridge Park Pl Ste 3, Louisville, KY 40222-3450 | 2018-08-01 |
| 1437645934 | Flourish Louisville | Psychologist | 6000 Brownsboro Park Blvd Ste A, Louisville, KY 40207-7201 | 2018-07-09 |
| 1982197737 | Louisville Center for Eating Disorders LLC | Psychologist | 11824 Ransum Dr # 200, Louisville, KY 40243-2802 | 2018-06-07 |
| 1801305461 | Elizabeth Swabek | Psychologist | 3703 Taylorsville Rd Ste 221, Louisville, KY 40220-1331 | 2017-09-27 |
| 1487173712 | The Wright Psychology and Learning Center, Pllc | Psychologist | 4010 Dupont Cir Ste 401, Louisville, KY 40207-4887 | 2017-09-19 |
| 1013371699 | Deshields Behavioral Wellness, Inc. | Psychologist | 2515 Gardiner Ln, Louisville, KY 40205-3003 | 2016-04-08 |
| 1306235452 | Katrina Mcbride | Psychologist | 6009 Brownsboro Park Blvd Ste C, Louisville, KY 40207-1291 | 2015-01-13 |
| 1265820211 | Russell Howard Williams | Psychologist | 11803 Robindale Rd, Louisville, KY 40243-1338 | 2014-12-29 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40243 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.