Provider Demographics
NPI:1427801059
Name:SHASTA HICKMAN COUNSELING AND COACHING PLLC
Entity type:Organization
Organization Name:SHASTA HICKMAN COUNSELING AND COACHING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WONDER
Authorized Official - Prefix:
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:971-303-9868
Mailing Address - Street 1:12306 SE MILL PLAIN BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6072
Mailing Address - Country:US
Mailing Address - Phone:971-303-9868
Mailing Address - Fax:
Practice Address - Street 1:12306 SE MILL PLAIN BLVD STE 250
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6072
Practice Address - Country:US
Practice Address - Phone:971-303-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)