Provider Demographics
NPI:1114352655
Name:VERN RICKERT COUNSELING
Entity Type:Organization
Organization Name:VERN RICKERT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW LMFT
Authorized Official - Phone:502-592-8195
Mailing Address - Street 1:17501 FISHERVILLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-9781
Mailing Address - Country:US
Mailing Address - Phone:502-592-8195
Mailing Address - Fax:502-618-2609
Practice Address - Street 1:9319 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1737
Practice Address - Country:US
Practice Address - Phone:502-618-1201
Practice Address - Fax:502-618-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty