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General NPI Number Information
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NPI Number | 1407921661
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Entity Type | Individual
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Provider Name | DENNIS R HICKS MFT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11600 WASHINGTON PL STE 201
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City | LOS ANGELES
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State | CA
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Zip | 90066-5068
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Country | US
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Telephone | 310-390-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 938 MARCO PL
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City | VENICE
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State | CA
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Zip | 90291-3920
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Country | US
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Telephone | 310-823-9556
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Fax | 310-306-2296
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT27240
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License Number State | CA
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