1881030468 NPI number — DR. MARIAN BLEDSOE HICKS MED LPC LMFT PHD

Table of content: DR. MARIAN BLEDSOE HICKS MED LPC LMFT PHD (NPI 1881030468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881030468 NPI number — DR. MARIAN BLEDSOE HICKS MED LPC LMFT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
MARIAN
Provider Middle Name:
BLEDSOE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MED LPC LMFT PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1881030468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX #563
Provider Second Line Business Mailing Address:
690 AN CO RD #360
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-723-2451
Provider Business Mailing Address Fax Number:
903-723-2451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 ANDERSON CO ROAD # 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75803-0000
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:
903-723-2451
Provider Enumeration Date:
05/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  11657 , 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: 3397 , 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)





Copyright © 2007-2025 www.npivalidator.com