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NPI Code Detail

MEDICARE: TARA ELIZABETH HICKS

MEDICARE: TARA ELIZABETH HICKS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor30703MT

General Provider Information

NPI Number : 1558827410
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ELIZABETH HICKS
Provider Business Mailing Address
First Line : 325 7TH AVE W
Second Line :
City : KALISPELL
State : MT
Zip : 59901-4761
Country : US
Telephone Number : 406-407-6239
Fax Number :
Provider Business Practice Location Address
First Line : 390 HODGSON RD
Second Line :
City : COLUMBIA FALLS
State : MT
Zip : 59912-9063
Country : US
Telephone Number : 406-871-6738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 02/15/2019

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Directions to “ TARA ELIZABETH HICKS ” Practice Location

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