Provider Demographics
NPI:1417111469
Name:RICO, GREGORY ANDREW (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ANDREW
Last Name:RICO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 RAWLINS ST.
Mailing Address - Street 2:STE. 1370
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-207-4163
Mailing Address - Fax:214-780-3746
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:STE 1370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4217
Practice Address - Country:US
Practice Address - Phone:214-207-4163
Practice Address - Fax:214-780-3812
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional