Individual
MR. JEDEDIAH LARICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1207 N CLAY ST APT 1, ENNIS, TX 75119-2346
(956) 933-0709
Mailing address
1207 N CLAY ST APT 1, ENNIS, TX 75119-2346
(956) 933-0709
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14222
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14222
LICENSED CHEMICAL DEPENDENCY COUNSELOR
TX
Enumeration date
02/19/2025
Last updated
04/04/2025
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