Provider Demographics
NPI:1235344383
Name:PRESTON, RICKEAL L (MS, LBP)
Entity Type:Individual
Prefix:
First Name:RICKEAL
Middle Name:L
Last Name:PRESTON
Suffix:
Gender:F
Credentials:MS, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BLACK BIRD LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7425
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:405-360-2252
Practice Address - Street 1:2502 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2503
Practice Address - Country:US
Practice Address - Phone:580-226-9388
Practice Address - Fax:580-226-9395
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health