Provider Demographics
NPI:1003276726
Name:HICKS, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 BONNYCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7804
Mailing Address - Country:US
Mailing Address - Phone:918-693-0411
Mailing Address - Fax:
Practice Address - Street 1:10230 BONNYCASTLE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7804
Practice Address - Country:US
Practice Address - Phone:918-693-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical