Provider Demographics
NPI:1417006321
Name:JEREZ, RICARDO ALBERTO (LPC)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ALBERTO
Last Name:JEREZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2215 NW CACHE ROAD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6328
Mailing Address - Country:US
Mailing Address - Phone:580-351-9998
Mailing Address - Fax:580-351-9898
Practice Address - Street 1:2215 NW CACHE ROAD
Practice Address - Street 2:SUITE #107
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6328
Practice Address - Country:US
Practice Address - Phone:580-351-9998
Practice Address - Fax:580-351-9898
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional