Provider Demographics
NPI:1861444051
Name:RICKETTS, ROBERT WILLIAM (LPC, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:RICKETTS
Suffix:
Gender:M
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ESTATES DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4295
Mailing Address - Country:US
Mailing Address - Phone:325-677-3172
Mailing Address - Fax:325-677-3176
Practice Address - Street 1:1150 ESTATES DR
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4295
Practice Address - Country:US
Practice Address - Phone:325-677-3172
Practice Address - Fax:325-677-3176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4912101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor