Provider Demographics
NPI:1902933245
Name:ROEPKE, RICK (DMIN, CCMFT)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:ROEPKE
Suffix:
Gender:M
Credentials:DMIN, CCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911B SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3303
Mailing Address - Country:US
Mailing Address - Phone:270-746-0283
Mailing Address - Fax:270-746-9679
Practice Address - Street 1:1911B SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3303
Practice Address - Country:US
Practice Address - Phone:270-746-0283
Practice Address - Fax:270-746-9679
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
109621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist