Provider Demographics
NPI:1063715050
Name:HICKS, SUZANNA (LMHC)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-1519
Mailing Address - Country:US
Mailing Address - Phone:260-563-8452
Mailing Address - Fax:260-569-0335
Practice Address - Street 1:206 NORTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962
Practice Address - Country:US
Practice Address - Phone:260-563-8452
Practice Address - Fax:260-569-0339
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002048A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health