MEDICARE: RICHARD T. DINES LTD. PSY.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6361001126	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P108952070	OTHER	MI	INDIVIDUAL BCBS PIN #

General Provider Information

NPI Number	:	1215080254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD T. DINES LTD. PSY.

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 APPLEGATE LN
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2118
Country	:	US
Telephone Number	:	517-290-7672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/09/2025

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