Provider Demographics
NPI:1306324884
Name:WALTER, RICKY (LPC)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:WALTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 W HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-9296
Mailing Address - Country:US
Mailing Address - Phone:903-872-8228
Mailing Address - Fax:903-872-2788
Practice Address - Street 1:5301 W HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-9296
Practice Address - Country:US
Practice Address - Phone:903-872-8228
Practice Address - Fax:903-872-2788
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional