Provider Demographics
NPI:1063773414
Name:HUGGINS, RICKY LEE (LADC)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:LEE
Last Name:HUGGINS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46100 LOVINGS LN
Mailing Address - Street 2:
Mailing Address - City:HEAVENER
Mailing Address - State:OK
Mailing Address - Zip Code:74937-9120
Mailing Address - Country:US
Mailing Address - Phone:479-650-9691
Mailing Address - Fax:
Practice Address - Street 1:46100 LOVINGS LN
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-9120
Practice Address - Country:US
Practice Address - Phone:479-650-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20043221OAMedicaid