Russell James Bailey, PH.D.
Individual provider Active NPI Clinical Psychologist · Provo, UT
NPI 1851693808 · NPPES record last updated Nov 24, 2010
Key facts
- NPI
- 1851693808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 7809881-2504 (UT)
- Practice address
- 1675 N Freedom Blvd
Suite 2B2
Provo, UT 84604-2540 - Phone
- (801) 360-7598
- NPI assigned
- Nov 24, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7809881-2504 | UT | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7809881-2504 | UT | Yes |
Addresses
Primary practice location
1675 N Freedom Blvd
Suite 2B2
Provo, UT 84604-2540
Mailing address
1675 N Freedom Blvd
Suite 2B2
Provo, UT 84604-2540
Phone (801) 360-7598
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.