1992809909 NPI number — BLAIR HAREN HICKMAN MSSW LCSW

Table of content: BLAIR HAREN HICKMAN MSSW LCSW (NPI 1992809909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992809909 NPI number — BLAIR HAREN HICKMAN MSSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKMAN
Provider First Name:
BLAIR
Provider Middle Name:
HAREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSSW LCSW
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:
1992809909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
926 W OAKLAND AVE
Provider Second Line Business Mailing Address:
SUITE 226
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-262-0317
Provider Business Mailing Address Fax Number:
423-262-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 W OAKLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-262-0317
Provider Business Practice Location Address Fax Number:
423-262-0311
Provider Enumeration Date:
09/11/2006

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: 104100000X , with the licence number:  LSW3260 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1047231 . This is a "CIGNA-MCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100676 . This is a "UBH-HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3697987 . This is a "MEDICARE-TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3085266 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351654200 . This is a "DOL WORKERS COMP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com