MEDICARE: ROD HICKMAN MSSW

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	101YP2500X	Professional Counselor	3392	TX
2	1041C0700X	Clinical Social Worker	8680	TX
3	106H00000X	Marriage & Family Therapist	495 488	TX

General Provider Information

NPI Number	:	1326199456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROD HICKMAN MSSW

Provider Business Mailing Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 911
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-338-0420
Fax Number	:	817-338-0370

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 911
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-338-0420
Fax Number	:	817-338-0370

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	09/11/2025

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Directions to “ ROD HICKMAN MSSW” Practice Location

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