Provider Demographics
NPI:1417725417
Name:VETTICKAL, RIYA RONEY
Entity Type:Individual
Prefix:
First Name:RIYA
Middle Name:RONEY
Last Name:VETTICKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 BISSONNET ST STE 289
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3112
Mailing Address - Country:US
Mailing Address - Phone:832-463-2502
Mailing Address - Fax:
Practice Address - Street 1:4545 BISSONNET ST STE 289
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3112
Practice Address - Country:US
Practice Address - Phone:832-463-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional