Provider Demographics
NPI:1427549013
Name:RICOTTA, STACY ANN (MS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:RICOTTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 ELLA LEE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4021
Mailing Address - Country:US
Mailing Address - Phone:346-221-8984
Mailing Address - Fax:
Practice Address - Street 1:5909 WEST LOOP S STE 557
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2404
Practice Address - Country:US
Practice Address - Phone:895-171-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health