MEDICARE: TRAVIS HICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-18-50390	FL
2	103K00000X	Behavior Analyst	12368983	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295394104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS HICKS

Provider Business Mailing Address
First Line	:	4620 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5884
Country	:	US
Telephone Number	:
Fax Number	:	772-221-9969

Provider Business Practice Location Address
First Line	:	4163 NW FEDERAL HWY STE 22CD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3623
Country	:	US
Telephone Number	:	877-591-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/26/2025

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Directions to “ TRAVIS HICKS ” Practice Location

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