1861743361 NPI number — AUNJULI A. HICKS LPC LIMITED LIABILITY COMPANY

Table of content: (NPI 1861743361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861743361 NPI number — AUNJULI A. HICKS LPC LIMITED LIABILITY COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUNJULI A. HICKS LPC LIMITED LIABILITY COMPANY
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:
HICKS GROUP ALTERNATIVE MENTAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1861743361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 MILLBURN AVE STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLBURN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07041-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-364-7611
Provider Business Mailing Address Fax Number:
908-913-0912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 MILLBURN AVE STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLBURN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07041-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-364-7611
Provider Business Practice Location Address Fax Number:
908-913-0912
Provider Enumeration Date:
09/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
AUNJULI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGING DIRECTOR
Authorized Official Telephone Number:
908-364-7611

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  37PC00408800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 37PC00408800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 37AC00029500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041S0200X , with the licence number: 506814 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1225361157 . This is a "NPI INDIVIDUAL PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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