Provider Demographics
NPI:1326199456
Name:HICKMAN, ROD (MSSW)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER RUN
Mailing Address - Street 2:SUITE 911
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6579
Mailing Address - Country:US
Mailing Address - Phone:817-338-0420
Mailing Address - Fax:817-338-0370
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 911
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-338-0420
Practice Address - Fax:817-338-0370
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3392101YP2500X
TX86801041C0700X
TX495 488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist