Healthcare Provider Details

I. General information

NPI: 1164360202
Provider Name (Legal Business Name): MICHAEL HICKS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 HARRISON AVE STE 200
COLUMBUS OH
43215-1300
US

IV. Provider business mailing address

196 S GRANT AVE APT 308
COLUMBUS OH
43215-8365
US

V. Phone/Fax

Practice location:
  • Phone: 614-940-4868
  • Fax: 614-372-5145
Mailing address:
  • Phone: 614-440-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.0500744
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: