Provider Demographics
NPI:1598969461
Name:CLEMENTS, RICKY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:LEE
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 S MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3741
Mailing Address - Country:US
Mailing Address - Phone:435-691-2256
Mailing Address - Fax:
Practice Address - Street 1:1194 S MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3741
Practice Address - Country:US
Practice Address - Phone:435-586-4078
Practice Address - Fax:435-586-5631
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261856-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical