Individual provider Active NPI

Justin Lee Ricks, BA

  • Mental Health Counselor
  • San Jose, CA
National Provider Identifier
1770766933
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
232 E Gish Rd
San Jose, CA 95112-4706
Phone
(408) 876-4217
NPI assigned
Dec 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

232 E Gish Rd
San Jose, CA 95112-4706

Mailing address

520 Railway Ave Apt 287
Campbell, CA 95008-3036
Phone (408) 876-4217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Arts

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1770766933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 RAILWAY AVE APT 287",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950083036",
            "telephone_number": "408-876-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 E GISH RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951124706",
            "telephone_number": "408-876-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKS",
        "first_name": "JUSTIN",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.