Provider Demographics
NPI:1437270410
Name:KIMES, RICKY CORDALE (MA LPC)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:CORDALE
Last Name:KIMES
Suffix:
Gender:M
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 1:165 SAINT ROBERT PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3312
Mailing Address - Country:US
Mailing Address - Phone:573-528-7760
Mailing Address - Fax:
Practice Address - Street 1:165 SAINT ROBERT PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3312
Practice Address - Country:US
Practice Address - Phone:573-528-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4516101YP2500X
GALPC006246101YP2500X
MO2023045478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional