Individual
MR. RICKY BRIAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1000 LAKE ST APT 607, OAK PARK, IL 60301-1498
(312) 620-8080
Mailing address
1000 LAKE ST APT 607, OAK PARK, IL 60301-1498
(312) 307-3935
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
208.000749
IL
106H00000X
Marriage & Family Therapist
Primary
166001501
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208.000749
ILLINOIS AMFT LICENSE
IL
Enumeration date
10/01/2019
Last updated
10/04/2021
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