Provider Demographics
NPI:1740635176
Name:RICK BIESINGER LLC
Entity type:Organization
Organization Name:RICK BIESINGER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-804-1028
Mailing Address - Street 1:811 E 640 S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5652
Mailing Address - Country:US
Mailing Address - Phone:801-804-0125
Mailing Address - Fax:801-405-6753
Practice Address - Street 1:1220 N MAIN ST
Practice Address - Street 2:#4
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4013
Practice Address - Country:US
Practice Address - Phone:801-804-1028
Practice Address - Fax:801-405-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6331481-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1659554566Medicaid