Individual
DR. RICHARD G. ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3549 N UNIVERSITY AVE - SUITE 200, JAMESTOWN SQUARE -- YORKTOWN BLDG, PROVO, UT 84604-4417
(801) 377-2014
(801) 374-7449
Mailing address
1392 TURF FARM WAY STE 1-134, PAYSON, UT 84651-5587
(661) 609-0341
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY10083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11211945-2501
STATE LICENSE
UT
01
—
PSY10083
STATE LICENSE
CA
Enumeration date
01/08/2007
Last updated
02/10/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us