Provider Demographics
NPI:1285861203
Name:SOUTHWEST PSYCHOTHERAPY & COUNSELING, LLC.
Entity Type:Organization
Organization Name:SOUTHWEST PSYCHOTHERAPY & COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-293-1770
Mailing Address - Street 1:1661 N SWAN RD STE 200-2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4074
Mailing Address - Country:US
Mailing Address - Phone:520-293-1770
Mailing Address - Fax:520-747-1448
Practice Address - Street 1:1661 N SWAN RD STE 200-2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4074
Practice Address - Country:US
Practice Address - Phone:520-293-1770
Practice Address - Fax:520-747-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1104086388Other1104086388