Provider Demographics
NPI:1770729634
Name:WADSWORTH, RICK (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 JONES MALTSBERGER RD
Mailing Address - Street 2:420
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4282
Mailing Address - Country:US
Mailing Address - Phone:210-383-3180
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD
Practice Address - Street 2:420
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4282
Practice Address - Country:US
Practice Address - Phone:210-383-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-25
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20079101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health