Provider Demographics
NPI:1710920301
Name:RICE, DAVID L (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:RICE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:AZ
Mailing Address - Zip Code:85539-8725
Mailing Address - Country:US
Mailing Address - Phone:928-701-1476
Mailing Address - Fax:928-425-2893
Practice Address - Street 1:1478 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:AZ
Practice Address - Zip Code:85539-8725
Practice Address - Country:US
Practice Address - Phone:928-701-1476
Practice Address - Fax:928-425-2893
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ931354Medicaid