Provider Demographics
NPI:1336858125
Name:POPE, RICKY J JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:J
Last Name:POPE
Suffix:JR
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 1:1640 CAMINO DEL RIO N STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1523
Mailing Address - Country:US
Mailing Address - Phone:858-539-3402
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5724
Practice Address - Country:US
Practice Address - Phone:858-539-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33803103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling