Provider Demographics
NPI:1538553011
Name:RICKETTS, MYRA (LMHC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2581
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-2581
Mailing Address - Country:US
Mailing Address - Phone:352-287-9858
Mailing Address - Fax:
Practice Address - Street 1:3404 N LECANTO HWY
Practice Address - Street 2:STE D
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3569
Practice Address - Country:US
Practice Address - Phone:352-419-4856
Practice Address - Fax:352-877-4162
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011598101YM0800X
MECC7410101YM0800X
COLPC0015911101YM0800X
NH3417101YM0800X
FLMH16109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health