Basic Information
| Provider Information | |||||||||
| NPI: | 1871516286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOMAX | ||||||||
| FirstName: | RICKY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 ATHENA WAY | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633764804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362331396 | ||||||||
| FaxNumber: | 3142063992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 ATHENA WAY | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633764804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362331396 | ||||||||
| FaxNumber: | 3142063992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 2005028641 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.