Rickey Etheridge, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P0907039 Issued in AR

Practice address

3348 Main St Ste 100
Bryant, AR 72022-5013

Phone

(501) 443-3824

Fax

(501) 521-1001

NPI assigned

Sep 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arkansas Counseling and Psychodiagnostics, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Arkadelphia, AR
  • NPI 1356838569
  NPD (past)
• Arkansas Counseling and Psychodiagnostics, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Arkadelphia, AR
  • NPI 1902060684
  NPD (past)

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1861594483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3348 MAIN ST STE 100",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720225013",
            "telephone_number": "501-443-3824",
            "fax_number": "501-521-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3348 MAIN ST STE 100",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720225013",
            "telephone_number": "501-443-3824",
            "fax_number": "501-521-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11501 Huron Ln Ste 5",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722112491",
            "country_code": "US",
            "telephone_number": "501-904-4762",
            "fax_number": "501-708-2185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "RICKEY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-03",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P0907039",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P0907039",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Embry, LCSW
• Eric Sharks DDS PLLC
• Brandi Nichole Erwin
• Esquared Therateam Co LLC
• Estelle a. Rutledge, M.D., PA
• Michael E. Eubanks, LMSW
• William Tyler Everitt, OTA
• Excel Health Inc
• Caleb Fanning
• Robert Wayne Farley

• Professional Counselor in Bryant, AR
• Providers in Bryant, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.