Provider Demographics
NPI:1437116779
Name:GIRARD, RUSSELL D (LPC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:D
Last Name:GIRARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:1000 STARR AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1821
Practice Address - Country:US
Practice Address - Phone:715-858-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3605125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33684OtherSECURITY HEALTH PLAN
MNHP57327OtherHEALTH PARTNERS
MN31B54GIOtherBCBS MN
MN637871026349OtherPREFERRED ONE
WI41001400Medicaid
MN6206017OtherMEDICA UBH UHC