Provider Demographics
NPI:1497273189
Name:FLICK, RICHARD JUSTIN (BCBA,COBA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JUSTIN
Last Name:FLICK
Suffix:
Gender:M
Credentials:BCBA,COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 S CADILLAC DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3320
Mailing Address - Country:US
Mailing Address - Phone:234-866-0141
Mailing Address - Fax:
Practice Address - Street 1:1051 TIFFANY S STE A
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1977
Practice Address - Country:US
Practice Address - Phone:856-629-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHCOBA.00929103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)