Provider Demographics
NPI:1275236127
Name:RICKARD, JASON (LPCC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RICKARD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1907
Mailing Address - Country:US
Mailing Address - Phone:270-537-4778
Mailing Address - Fax:
Practice Address - Street 1:503 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1907
Practice Address - Country:US
Practice Address - Phone:270-537-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional