Provider Demographics
NPI:1205562063
Name:PRICKETT, WILLIAM (LPA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PRICKETT
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-3506
Mailing Address - Country:US
Mailing Address - Phone:940-595-2798
Mailing Address - Fax:
Practice Address - Street 1:3214 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-3506
Practice Address - Country:US
Practice Address - Phone:940-595-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist