Doctor Name: | MR. HALLE RICKETTS |
NPI Number: | 1033367719 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW LICSW/LCSW LSSW |
License Number: | 14301 |
Business Practice Address: | 121 N Lynch St Grenada, MS - 389012004 |
Business Phone Number: | 6012260284 |
Business Fax Number: | |
Mailing Address: | 121 N Lynch St, GRENADA |
State: | MS |
Postal Code: | 389012004 |
Phone Number: | 6012260284 |
Fax Number: | |
NPI Enumeration Date: | 09/05/2008 |
NPI Last Update Date: | 09/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 14301 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |