Individual
MR. HALLE RICKETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW LICSW/LCSW LSSW
Contact information
Practice address
121 N LYNCH ST, GRENADA, MS 38901-2004
(601) 226-0284
Mailing address
121 N LYNCH ST, GRENADA, MS 38901-2004
(601) 226-0284
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
14301
MN
1041C0700X
Clinical Social Worker
Primary
C6249
MS
1041S0200X
School Social Worker
383604
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149722700
—
MN
Enumeration date
09/05/2008
Last updated
09/05/2008
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