Provider Demographics
NPI:1124820790
Name:MOLINA, RICCI DEAN JR
Entity type:Individual
Prefix:
First Name:RICCI
Middle Name:DEAN
Last Name:MOLINA
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:NM
Mailing Address - Zip Code:87728-0196
Mailing Address - Country:US
Mailing Address - Phone:575-621-0098
Mailing Address - Fax:
Practice Address - Street 1:243 COOK AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3930
Practice Address - Country:US
Practice Address - Phone:580-319-5770
Practice Address - Fax:580-319-7086
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRBT-25-421568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician