Provider Demographics
NPI:1720535917
Name:RICKARD, WESLEY (LPC)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:
Last Name:RICKARD
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 1:6530 SECOR RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9456
Mailing Address - Country:US
Mailing Address - Phone:734-854-7061
Mailing Address - Fax:530-654-7061
Practice Address - Street 1:6530 SECOR RD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9456
Practice Address - Country:US
Practice Address - Phone:734-854-7061
Practice Address - Fax:530-654-7061
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional