Provider Demographics
NPI:1366084162
Name:RUSS, CHRISTY Y (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:Y
Last Name:RUSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 BRENTWOOD HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7970
Mailing Address - Country:US
Mailing Address - Phone:615-589-8827
Mailing Address - Fax:
Practice Address - Street 1:1236 BRENTWOOD HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7970
Practice Address - Country:US
Practice Address - Phone:615-589-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6892104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker