Provider Demographics
NPI:1275183675
Name:HICKS, MEGAN LAUREN (TLMHC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LAUREN
Last Name:HICKS
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3622
Mailing Address - Country:US
Mailing Address - Phone:641-417-8700
Mailing Address - Fax:
Practice Address - Street 1:610 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2221
Practice Address - Country:US
Practice Address - Phone:515-465-7541
Practice Address - Fax:515-465-7636
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health