Provider Demographics
NPI:1881328946
Name:RICKS, SEAN THOMAS (MDIV)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:THOMAS
Last Name:RICKS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 MARY LOU LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8389
Mailing Address - Country:US
Mailing Address - Phone:321-408-2178
Mailing Address - Fax:
Practice Address - Street 1:3675 MARY LOU LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8389
Practice Address - Country:US
Practice Address - Phone:321-408-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral