Provider Demographics
NPI:1487734497
Name:HICKS COUNSELING SERVS
Entity type:Organization
Organization Name:HICKS COUNSELING SERVS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HICKS COUNSELING SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC LMFT CCJS
Authorized Official - Phone:903-723-2451
Mailing Address - Street 1:POB 563
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802
Mailing Address - Country:US
Mailing Address - Phone:214-557-8961
Mailing Address - Fax:903-723-2471
Practice Address - Street 1:690 ANCORD
Practice Address - Street 2:#360
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803
Practice Address - Country:US
Practice Address - Phone:903-723-2451
Practice Address - Fax:903-723-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3397LMFT106H00000X
TX11657LPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162927101Medicaid
TX2515LCOtherBCBS