1487734497 NPI number — HICKS COUNSELING SERVS

Table of content: (NPI 1487734497)

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:
Provider Other Organization Name Type Code:
6
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: 106H00000X , with the licence number:  3397LMFT , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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" .

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".




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