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General NPI Number Information
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NPI Number | 1649544487
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Entity Type | Organization
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Legal Business Name | PERCY RICKETTS, MS, LMHC, PA
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 10031 PINES BLVD STE 242
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6180
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Country | US
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Telephone | 954-438-5661
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Fax | 954-333-7694
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Provider Business Mailing Address
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Address Line | 10031 PINES BLVD STE 242
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6180
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Country | US
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Telephone | 954-438-5661
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Fax | 954-333-7694
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. PERCIVAL GEORGE RICKETTS
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Credential | EDD, LMHC
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Telephone | 954-438-5661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6153
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License Number State | FL
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