Provider Demographics
NPI:1528121712
Name:JONES, FREDERIC HICKS (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:HICKS
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20011 CAMBRIA CT
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4253
Mailing Address - Country:US
Mailing Address - Phone:707-852-0440
Mailing Address - Fax:
Practice Address - Street 1:37491 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4386
Practice Address - Country:US
Practice Address - Phone:530-335-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CAPSY 22736103TC0700X
CACORPHQ-144-072008S103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)