Healthcare Provider Details

I. General information

NPI: 1104155209
Provider Name (Legal Business Name): RICKELLE ROSE HICKS M.A. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RICKELLE ROSE SMYTH

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 N RIVER RD
PALISADE CO
81526-9763
US

IV. Provider business mailing address

353 N RIVER RD
PALISADE CO
81526-9763
US

V. Phone/Fax

Practice location:
  • Phone: 970-778-1524
  • Fax:
Mailing address:
  • Phone: 970-778-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number941
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: