Provider Demographics
NPI:1144758038
Name:RICKARDS, DANIEL ANDREW
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:RICKARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-3424
Mailing Address - Country:US
Mailing Address - Phone:863-697-1993
Mailing Address - Fax:
Practice Address - Street 1:11655 US HIGHWAY 441 SE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-1308
Practice Address - Country:US
Practice Address - Phone:863-697-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program