Provider Demographics
NPI:1275157562
Name:HICKEY, CHRISTOPHER JON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JON
Last Name:HICKEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 THE ALAMEDA STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1700
Mailing Address - Country:US
Mailing Address - Phone:408-491-9370
Mailing Address - Fax:
Practice Address - Street 1:1885 THE ALAMEDA STE 130
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1700
Practice Address - Country:US
Practice Address - Phone:408-491-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14672654OtherCAQH