Provider Demographics
NPI:1740388255
Name:HANFORD, RUSSELL BRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:BRETT
Last Name:HANFORD
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 1:2045 MCGILVRA BLVD E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2721
Mailing Address - Country:US
Mailing Address - Phone:206-409-9613
Mailing Address - Fax:
Practice Address - Street 1:1728 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2733
Practice Address - Country:US
Practice Address - Phone:206-409-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist