Provider Demographics
NPI:1194878488
Name:ARIAS-RICKETTS, LUCY
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:ARIAS-RICKETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3587
Mailing Address - Country:US
Mailing Address - Phone:214-460-5535
Mailing Address - Fax:
Practice Address - Street 1:616 W RUSSELL PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154759805Medicaid
TX154759803Medicaid
TX154759804Medicaid
TX87307QOtherBLUE CROSS BLUE SHIELD
TX8B7284Medicare ID - Type UnspecifiedALL OTHER COUNTIES
TX8A5146Medicare ID - Type UnspecifiedTARRANT COUNTY
TX154759805Medicaid