Provider Demographics
NPI:1285008441
Name:HICKLE, HERBERT GRANT (PLPC)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:GRANT
Last Name:HICKLE
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-4740
Mailing Address - Country:US
Mailing Address - Phone:337-231-6365
Mailing Address - Fax:
Practice Address - Street 1:100 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-4740
Practice Address - Country:US
Practice Address - Phone:337-231-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3257101YA0400X
LA6210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6210OtherLPC BOARD