MEDICARE: DR. ROY CLIFFORD RICKER D.MIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	15760	TX

General Provider Information

NPI Number	:	1558676189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY CLIFFORD RICKER D.MIN

Provider Business Mailing Address
First Line	:	29455 SUMMIT RIDGE DR
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-4573
Country	:	US
Telephone Number	:	210-687-7655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-687-7655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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