Healthcare Provider Details

I. General information

NPI: 1841596830
Provider Name (Legal Business Name): ROBERT S HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4873 TIMBER RUN DR
RIVERTON UT
84096-7467
US

IV. Provider business mailing address

4873 TIMBER RUN DR
RIVERTON UT
84096-7467
US

V. Phone/Fax

Practice location:
  • Phone: 801-541-1897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8354025-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: