Provider Demographics
NPI:1992456123
Name:RICKS, SAMANTHA GAY (MA, LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GAY
Last Name:RICKS
Suffix:
Gender:F
Credentials:MA, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 HUDSON ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8032
Mailing Address - Country:US
Mailing Address - Phone:256-542-8421
Mailing Address - Fax:
Practice Address - Street 1:12800 HILLCREST RD UNIT A103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1524
Practice Address - Country:US
Practice Address - Phone:256-542-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87777101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty