Provider Demographics
NPI:1821251653
Name:RICKER, TAMMY IRENE (MA)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:IRENE
Last Name:RICKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:IRENE
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4054
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0054
Mailing Address - Country:US
Mailing Address - Phone:760-285-1603
Mailing Address - Fax:760-418-4303
Practice Address - Street 1:650 JOEL DR.
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:760-285-1603
Practice Address - Fax:760-418-4303
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC52112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health