Provider Demographics
NPI:1518140995
Name:DOUBET, RICKY ROBERT (LPC)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:ROBERT
Last Name:DOUBET
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2269
Mailing Address - Country:US
Mailing Address - Phone:573-442-5234
Mailing Address - Fax:
Practice Address - Street 1:202 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2269
Practice Address - Country:US
Practice Address - Phone:573-442-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional