Provider Demographics
NPI:1568638492
Name:RICKER, TOD M (LPC)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:M
Last Name:RICKER
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 1:220 S PINE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1670
Mailing Address - Country:US
Mailing Address - Phone:541-357-0046
Mailing Address - Fax:541-833-6323
Practice Address - Street 1:220 S PINE ST STE 102
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1670
Practice Address - Country:US
Practice Address - Phone:541-357-0046
Practice Address - Fax:541-833-6323
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional