Provider Demographics
NPI:1194941716
Name:HICKOX, MICHELLE (MASTERS LADC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HICKOX
Suffix:
Gender:F
Credentials:MASTERS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 NW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2804
Mailing Address - Country:US
Mailing Address - Phone:405-525-9508
Mailing Address - Fax:
Practice Address - Street 1:1549 NW 37TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2804
Practice Address - Country:US
Practice Address - Phone:405-525-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OK879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200079250 AMedicaid
OK200390770 AMedicaid