Individual
DR. RUSSELL DAVID SEIGENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
191 E 450 N, PROVIDENCE, UT 84332-8400
(435) 764-3206
(435) 752-0226
Mailing address
PO BOX 283, PROVIDENCE, UT 84332-0283
(435) 764-3206
(435) 752-0226
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1141192501
UT
103TB0200X
Cognitive & Behavioral Psychologist
1141192501
UT
103TC1900X
Counseling Psychologist
1141192501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100001424477
REGENCE BLUECROSS BLUESHIELD
UT
01
—
1200415
DESERET MUTUAL BENEFIT ADMISTRATION
UT
01
—
1346310869
UNITED HEALTHCARE
UT
Enumeration date
11/09/2006
Last updated
01/17/2017
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