Provider Demographics
NPI:1760069660
Name:PHIPPS, RICARDO MICHAEL (PHD, LCPC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:MICHAEL
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:PHD, LCPC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E NORMAL AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4200
Mailing Address - Country:US
Mailing Address - Phone:660-785-4000
Mailing Address - Fax:
Practice Address - Street 1:100 E NORMAL AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4200
Practice Address - Country:US
Practice Address - Phone:660-785-4014
Practice Address - Fax:660-785-4011
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020039217101YP2500X
MDLC10526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional