Provider Demographics
NPI:1477309649
Name:RICKS, ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RICKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 E JOHN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0060
Mailing Address - Country:US
Mailing Address - Phone:480-703-1272
Mailing Address - Fax:
Practice Address - Street 1:1355 N GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4073
Practice Address - Country:US
Practice Address - Phone:480-937-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health