Provider Demographics
NPI:1447491527
Name:HICKS, ALICE MARIE (MHR, LPC)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2123
Mailing Address - Country:US
Mailing Address - Phone:918-706-9711
Mailing Address - Fax:
Practice Address - Street 1:206 N 37TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2123
Practice Address - Country:US
Practice Address - Phone:918-706-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3846101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor