Provider Demographics
NPI:1578594503
Name:SCABBO, RUSSELL EDWIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EDWIN
Last Name:SCABBO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E WARWICK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1085
Mailing Address - Country:US
Mailing Address - Phone:989-463-2779
Mailing Address - Fax:989-463-2064
Practice Address - Street 1:317 E WARWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1085
Practice Address - Country:US
Practice Address - Phone:989-463-2779
Practice Address - Fax:989-463-2064
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005159103TC0700X, 103TC1900X, 103TF0000X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680B945070OtherBLUE CROSS BLUE SHIELD
MI0N57730002Medicare ID - Type UnspecifiedMEDICARE
MI0N14370Medicare UPIN