Provider Demographics
NPI:1407356199
Name:FERRELL, RICK
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:FERRELL
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:PO BOX 89356
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-0405
Mailing Address - Country:US
Mailing Address - Phone:813-609-0219
Mailing Address - Fax:888-979-6989
Practice Address - Street 1:11929 TWILIGHT DARNER PL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6513
Practice Address - Country:US
Practice Address - Phone:813-609-0219
Practice Address - Fax:888-979-6989
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YS0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool