MEDICARE: ROSALIND RICKS LAC

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	101YM0800X	Mental Health Counselor	LAC-21816	AZ

General Provider Information

NPI Number	:	1588351878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIND RICKS LAC

Provider Business Mailing Address
First Line	:	1425 W ELLIOT RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5142
Country	:	US
Telephone Number	:	480-223-0223
Fax Number	:	480-505-7061

Provider Business Practice Location Address
First Line	:	2509 S POWER RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-6696
Country	:	US
Telephone Number	:	480-223-0223
Fax Number	:	480-505-7061

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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Directions to “ ROSALIND RICKS LAC” Practice Location

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