Provider Demographics
NPI:1497801831
Name:RICKEY, LANA (PSYD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:RICKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH ROAD
Mailing Address - Street 2:SUTIE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4803
Mailing Address - Country:US
Mailing Address - Phone:310-984-3055
Mailing Address - Fax:
Practice Address - Street 1:160 S FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808
Practice Address - Country:US
Practice Address - Phone:714-998-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006031103T00000X
101YM0800X
TX36725103TC0700X
CA07084225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist