Provider Demographics
NPI:1194241745
Name:MYRICK, RAYCHELLE (LSW)
Entity type:Individual
Prefix:MS
First Name:RAYCHELLE
Middle Name:
Last Name:MYRICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:RAYCHELLE
Other - Middle Name:
Other - Last Name:MYRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:218 VALLEY ST # B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2912
Mailing Address - Country:US
Mailing Address - Phone:859-322-9646
Mailing Address - Fax:
Practice Address - Street 1:2347 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-440-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1215242631Medicaid