Provider Demographics
NPI:1467880609
Name:RICKS-JAMES, ELISE (MS, RAS)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:RICKS-JAMES
Suffix:
Gender:F
Credentials:MS, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 TORRANCE BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4814
Mailing Address - Country:US
Mailing Address - Phone:310-528-1911
Mailing Address - Fax:
Practice Address - Street 1:3510 TORRANCE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4814
Practice Address - Country:US
Practice Address - Phone:310-528-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty