Provider Demographics
NPI:1760015978
Name:SPIETH, RUSSELL EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:EDWARD
Last Name:SPIETH
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 1:8040 CORPORATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1282
Mailing Address - Country:US
Mailing Address - Phone:216-320-9621
Mailing Address - Fax:
Practice Address - Street 1:8040 CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1282
Practice Address - Country:US
Practice Address - Phone:216-320-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-16
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07811103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling