Provider Demographics
NPI:1346465267
Name:TALBOT, RUSSELL W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:W
Last Name:TALBOT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 E TABERNACLE ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2944
Mailing Address - Country:US
Mailing Address - Phone:435-673-2899
Mailing Address - Fax:435-673-0943
Practice Address - Street 1:561 E TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2944
Practice Address - Country:US
Practice Address - Phone:435-673-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264436-3501101YM0800X, 1041C0700X
UT27813101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)