Provider Demographics
NPI:1417779091
Name:HICKEN, JEFFREY ALAN (LMFT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:HICKEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S INTERSTATE PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-8601
Mailing Address - Country:US
Mailing Address - Phone:385-236-4500
Mailing Address - Fax:
Practice Address - Street 1:170 S INTERSTATE PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-8601
Practice Address - Country:US
Practice Address - Phone:385-236-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12273589-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist