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Individual

MR. RICKY LEE JENTONS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MALLP

Contact information

Practice address
18181 OAKWOOD BLVD, 311, DEARBORN, MI 48124-5032
(313) 271-8170
(313) 271-8353
Mailing address
18181 OAKWOOD BLVD, 311, DEARBORN, MI 48124-5032
(313) 271-8170
(313) 271-8353

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
6301005971
MI
103TC0700X
Clinical Psychologist
Primary
6301005971
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0N15280
APEX BEHAVIORAL HEALTH P.L.L.C. MEDICARE GROUP PIN NO.
MI
01
6301005971
LICENSE
MI
Enumeration date
10/15/2007
Last updated
05/20/2008
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