Ellsworth, Richard G.

Ellsworth, Richard G. is an sole proprietor health care provider with primary practice located at 3549 N University Ave - Suite 200 Jamestown Square -- Yorktown Bldg, Provo UT 84604-4417. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ellsworth, Richard G. can be contacted via phone (801) 377-2014.

Contact Information

Primary practice address
3549 N University Ave - Suite 200 Jamestown Square -- Yorktown Bldg Provo UT 84604-4417
Phone: (801) 377-2014
Fax: (801) 374-7449
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY10083 California

Profile Details

NPI number 1598814964
LBN Legal business name Ellsworth, Richard G.
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 8th, 2007
Last updated Feb 10th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598814964 NPPES
Utah Other 11211945-2501 STATE LICENSE
Utah Other PSY10083 STATE LICENSE

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