=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134073752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HICKMAN MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2026
-----------------------------------------------------
Last Update Date | 02/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 338 W 300 N STE 6
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84318-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-241-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 W 300 N STE 6
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84318-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-241-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KYLE ELMO HICKMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 435-241-7105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------