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General NPI Number Information
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NPI Number | 1033394358
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Entity Type | Individual
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Provider Name | JEFFREY BRYAN HICKMAN LPC
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Gender | Male
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Dates
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Enumeration Date | 01/05/2008
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 1551 E COUNTY LINE RD
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City | JACKSON
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State | MS
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Zip | 39211-1801
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Country | US
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Telephone | 601-906-0224
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Fax | 601-957-7344
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Provider Business Mailing Address
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Address Line | 1551 E COUNTY LINE RD
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City | JACKSON
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State | MS
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Zip | 39211-1801
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Country | US
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Telephone | 601-906-0224
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Fax | 601-957-7344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1305
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License Number State | MS
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