Healthcare Provider Details

I. General information

NPI: 1215080254
Provider Name (Legal Business Name): RICHARD T. DINES LTD. PSY.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 APPLEGATE LN
EAST LANSING MI
48823-2118
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-290-7672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361001126
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: