Provider Demographics
NPI:1508749029
Name:HICKS, JEREMY LEE (LMSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:HICKS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1242
Mailing Address - Country:US
Mailing Address - Phone:660-924-1655
Mailing Address - Fax:
Practice Address - Street 1:855 ARDUSER DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6278
Practice Address - Country:US
Practice Address - Phone:417-646-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250184071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical