Healthcare Provider Details

I. General information

NPI: 1568513422
Provider Name (Legal Business Name): THERESA HICKS INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 40TH AVE
YAKIMA WA
98908-4311
US

IV. Provider business mailing address

504 N 40TH AVE
YAKIMA WA
98908-4311
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-8041
  • Fax: 509-966-3283
Mailing address:
  • Phone: 509-965-8041
  • Fax: 509-966-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: THERESA W HICKS
Title or Position: PRESIDENT
Credential: ARNP
Phone: 509-469-6823