Provider Demographics
NPI:1700979598
Name:RICKS, KIRA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:LEE
Last Name:RICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 CHALEMEL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1480
Mailing Address - Country:US
Mailing Address - Phone:915-730-5390
Mailing Address - Fax:
Practice Address - Street 1:316 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2349
Practice Address - Country:US
Practice Address - Phone:915-730-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008501A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical