Healthcare Provider Details

I. General information

NPI: 1871516286
Provider Name (Legal Business Name): RICKY LEE LOMAX MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ATHENA WAY
SAINT PETERS MO
63376-4804
US

IV. Provider business mailing address

1110 ATHENA WAY
SAINT PETERS MO
63376-4804
US

V. Phone/Fax

Practice location:
  • Phone: 636-233-1396
  • Fax: 314-206-3992
Mailing address:
  • Phone: 636-233-1396
  • Fax: 314-206-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2005028641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: