Healthcare Provider Details

I. General information

NPI: 1134073752
Provider Name (Legal Business Name): HICKMAN MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W 300 N STE 6
HYDE PARK UT
84318-4044
US

IV. Provider business mailing address

338 W 300 N STE 6
HYDE PARK UT
84318-4044
US

V. Phone/Fax

Practice location:
  • Phone: 435-241-7105
  • Fax:
Mailing address:
  • Phone: 435-241-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KYLE ELMO HICKMAN
Title or Position: OWNER
Credential: LCSW
Phone: 435-241-7105