Healthcare Provider Details

I. General information

NPI: 1174076624
Provider Name (Legal Business Name): RICKI SEPULVADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W MISSISSIPPI AVE
MANY LA
71449-3133
US

IV. Provider business mailing address

910 W MISSISSIPPI AVE
MANY LA
71449-3133
US

V. Phone/Fax

Practice location:
  • Phone: 318-581-2889
  • Fax:
Mailing address:
  • Phone: 318-742-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: