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NPI Code Detail

MEDICARE: KRUSHAUD HICKS

MEDICARE: KRUSHAUD 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
1101Y00000XCounselor
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1548703614
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRUSHAUD HICKS
Provider Business Mailing Address
First Line : 2155 CHICAGO AVE STE 203
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2209
Country : US
Telephone Number : 951-357-6926
Fax Number : 855-568-2494
Provider Business Practice Location Address
First Line : 2155 CHICAGO AVE STE 203
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2209
Country : US
Telephone Number : 951-357-6926
Fax Number : 855-568-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2016
Last Update Date : 12/30/2022

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Directions to “ KRUSHAUD HICKS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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