Provider Demographics
NPI:1164001426
Name:BEARDALL, RICHARD J (AMFT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BEARDALL
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 W 200 S
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2755
Mailing Address - Country:US
Mailing Address - Phone:385-224-9741
Mailing Address - Fax:
Practice Address - Street 1:2139 W 200 S
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2755
Practice Address - Country:US
Practice Address - Phone:385-224-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist