MEDICARE: MR. JAMES THOMAS HICKS MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC11764	CA

General Provider Information

NPI Number	:	1306913728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES THOMAS HICKS MFT

Provider Business Mailing Address
First Line	:	179 17TH ST
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-2682
Country	:	US
Telephone Number	:	831-595-4686
Fax Number	:	831-417-1922

Provider Business Practice Location Address
First Line	:	179 17TH ST
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-2682
Country	:	US
Telephone Number	:	831-595-4686
Fax Number	:	831-417-1922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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