Provider Demographics
NPI:1396340337
Name:BINGHAM, RICK DAVID
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:DAVID
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 MISTY WAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4865
Mailing Address - Country:US
Mailing Address - Phone:972-897-6683
Mailing Address - Fax:972-495-5827
Practice Address - Street 1:2340 E TRINITY MILLS RD STE 335
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1942
Practice Address - Country:US
Practice Address - Phone:972-897-6683
Practice Address - Fax:973-897-6683
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)