Basic Information
| Provider Information | |||||||||
| NPI: | 1003146499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICARD | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MAPC, LPCC-S, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416 | ||||||||
| Address2: | |||||||||
| City: | LOYALL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 408540416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066215220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 306 CARTER AVENUE | ||||||||
| Address2: | CITY HALL BLDG, ROOM 4 | ||||||||
| City: | LOYALL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 30854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066215220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2010 | ||||||||
| LastUpdateDate: | 05/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPCPCC00222652 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7100368520 | 05 | KY | MEDICAID |