Provider Information for 1598969461
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RICKY LEE CLEMENTS LCSW
Sex: Male
NPI: 1598969461
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1598969461 | ||||||||
| Enumeration Date | 2007-06-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1194 S MOUNTAIN VIEW DR CEDAR CITY, UT 84720-3741 United States Phone: 435-691-2256 | Fax: | ||||||||
| Primary Practice Address | 1194 S MOUNTAIN VIEW DR CEDAR CITY, UT 84720-3741 United States Phone: 435-586-4078 | Fax:435-586-5631 | ||||||||
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