1487734497 NPI number — HICKS COUNSELING SERVS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487734497 NPI number — HICKS COUNSELING SERVS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HICKS COUNSELING SERVS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOLE PROPRIETY OWNERSHIP OF MARIAN B HICKS COUNSELING SERVS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487734497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-557-8961
Provider Business Mailing Address Fax Number:
903-723-2471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 ANCORD
Provider Second Line Business Practice Location Address:
#360
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-723-2451
Provider Business Practice Location Address Fax Number:
903-723-2471
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
MARIAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
HICKS COUNSELING SERVICES
Authorized Official Telephone Number:
903-723-2451

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  11657LPC , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 3397LMFT , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162927101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2515LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com