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General NPI Number Information
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NPI Number | 1073566220
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Entity Type | Individual
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Provider Name | VERNON C RICKERT JR. LCSW LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 9319 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40299-1737
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Country | US
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Telephone | 502-592-8195
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Fax | 502-618-2609
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Provider Business Mailing Address
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Address Line | 17501 FISHERVILLE WOODS DR
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City | FISHERVILLE
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State | KY
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Zip | 40023-9781
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Country | US
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Telephone | 502-267-5418
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Fax | 502-618-2609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0214
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0252
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License Number State | KY
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