Provider Demographics
NPI:1558676189
Name:RICKER, ROY CLIFFORD (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:CLIFFORD
Last Name:RICKER
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29455 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4573
Mailing Address - Country:US
Mailing Address - Phone:210-687-7655
Mailing Address - Fax:
Practice Address - Street 1:1931 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2153
Practice Address - Country:US
Practice Address - Phone:210-687-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional