Provider Demographics
NPI:1356498661
Name:HICKMAN, MEGGAN HAESCHE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MEGGAN
Middle Name:HAESCHE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MEGGAN
Other - Middle Name:ELIZABETH
Other - Last Name:HAESCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 15962
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0962
Mailing Address - Country:US
Mailing Address - Phone:562-595-0075
Mailing Address - Fax:
Practice Address - Street 1:12842 VALLEY VIEW ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2515
Practice Address - Country:US
Practice Address - Phone:562-595-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist