Doctor Name: | DR. RICKY DON ERTELL |
NPI Number: | 1962656025 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC-S |
License Number: | 59803 |
Business Practice Address: | 9110 Timberwood Dr Richwood, TX - 775312772 |
Business Phone Number: | 9797091440 |
Business Fax Number: | |
Mailing Address: | 9110 Timberwood Dr, RICHWOOD |
State: | TX |
Postal Code: | 775312772 |
Phone Number: | 9797091440 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2008 |
NPI Last Update Date: | 11/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 59803 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |