Active NPI
Russell David Seigenberg, PH.D.
- Psychologist
- Providence, UT
National Provider Identifier
1346310869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1141192501
- Practice address
- 191 E 450 N
Providence, UT 84332-8400 - Phone
- (435) 764-3206
- Fax
- (435) 752-0226
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1141192501 | UT | Primary |
| Counseling Psychologist | 103TC1900X | 1141192501 | UT | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1141192501 | UT |
Addresses
Primary practice location
191 E 450 N
Providence, UT 84332-8400
Mailing address
PO Box 283
Providence, UT 84332-0283
Phone (435) 764-3206
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100001424477 | Other | UT | REGENCE BLUECROSS BLUESHIELD |
| 1200415 | Other | UT | DESERET MUTUAL BENEFIT ADMISTRATION |
| 1346310869 | Other | UT | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484611200000",
"number": "1346310869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 283",
"city": "PROVIDENCE",
"state": "UT",
"postal_code": "843320283",
"telephone_number": "435-764-3206",
"fax_number": "435-752-0226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 E 450 N",
"city": "PROVIDENCE",
"state": "UT",
"postal_code": "843328400",
"telephone_number": "435-764-3206",
"fax_number": "435-752-0226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEIGENBERG",
"first_name": "RUSSELL",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2017-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "UT",
"license": "1141192501",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "UT",
"license": "1141192501",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "UT",
"license": "1141192501",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUECROSS BLUESHIELD",
"identifier": "100001424477",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL BENEFIT ADMISTRATION",
"identifier": "1200415",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1346310869",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.