Provider Demographics
NPI:1780932616
Name:LEE-PERALES, RIKKI LAUREN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RIKKI
Middle Name:LAUREN
Last Name:LEE-PERALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:LAUREN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-0189
Mailing Address - Country:US
Mailing Address - Phone:573-265-3251
Mailing Address - Fax:573-265-0156
Practice Address - Street 1:13160 COUNTY ROAD 3610
Practice Address - Street 2:
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-0156
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023789104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker