Provider Demographics
NPI:1962656025
Name:ERTELL, RICKY DON (LPC-S)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:DON
Last Name:ERTELL
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77531-2772
Mailing Address - Country:US
Mailing Address - Phone:979-709-1440
Mailing Address - Fax:
Practice Address - Street 1:9110 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:TX
Practice Address - Zip Code:77531-2772
Practice Address - Country:US
Practice Address - Phone:979-709-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01-1827263Medicaid