Provider Demographics
NPI:1447761291
Name:RICKS, SHANNON (LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RICKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9752 S KATO DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-1237
Mailing Address - Country:US
Mailing Address - Phone:801-643-2422
Mailing Address - Fax:
Practice Address - Street 1:111 E 5600 S STE 105
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8155
Practice Address - Country:US
Practice Address - Phone:801-695-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8358035-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist