Provider Demographics
NPI:1588790414
Name:RICKEY, PATRICIA GAIL (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:GAIL
Last Name:RICKEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4351
Mailing Address - Country:US
Mailing Address - Phone:970-382-9301
Mailing Address - Fax:970-382-9301
Practice Address - Street 1:215 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4351
Practice Address - Country:US
Practice Address - Phone:970-382-9301
Practice Address - Fax:970-382-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000D3878Medicaid