Provider Demographics
NPI:1720451032
Name:DR. W. WAYNE RICKARD
Entity Type:Organization
Organization Name:DR. W. WAYNE RICKARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:615-543-4667
Mailing Address - Street 1:102 HAZEL PATH STE 5
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3889
Mailing Address - Country:US
Mailing Address - Phone:615-543-4667
Mailing Address - Fax:
Practice Address - Street 1:102 HAZEL PATH STE 5
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3889
Practice Address - Country:US
Practice Address - Phone:615-543-4667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE LESSONS THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT0000001161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty