Provider Demographics
NPI:1821211632
Name:PRICKETT, JAMES ROYAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROYAL
Last Name:PRICKETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10616 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6646
Mailing Address - Country:US
Mailing Address - Phone:515-438-3513
Mailing Address - Fax:515-438-3573
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-3513
Practice Address - Fax:515-438-3573
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00251101YM0800X
MNLP2728103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities