Provider Demographics
NPI:1649544487
Name:PERCY RICKETTS, MS, LMHC, PA
Entity type:Organization
Organization Name:PERCY RICKETTS, MS, LMHC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PERCIVAL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMHC
Authorized Official - Phone:954-438-5661
Mailing Address - Street 1:10031 PINES BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6180
Mailing Address - Country:US
Mailing Address - Phone:954-438-5661
Mailing Address - Fax:954-333-7694
Practice Address - Street 1:10031 PINES BLVD STE 242
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6180
Practice Address - Country:US
Practice Address - Phone:954-438-5661
Practice Address - Fax:954-333-7694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCY RICKETTS, MS, LMHC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty