Provider Demographics
NPI:1245570126
Name:WARE, RICKEY LAMAR
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:LAMAR
Last Name:WARE
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 1:5370 E CRAIG RD
Mailing Address - Street 2:2239-33
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2100
Mailing Address - Country:US
Mailing Address - Phone:702-601-0886
Mailing Address - Fax:
Practice Address - Street 1:5370 E CRAIG RD
Practice Address - Street 2:2239-33
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2100
Practice Address - Country:US
Practice Address - Phone:702-601-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health