Provider Demographics
NPI:1467645945
Name:HICKOX, HOWARD J (BS, CADC)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:J
Last Name:HICKOX
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74343-0514
Mailing Address - Country:US
Mailing Address - Phone:918-542-6369
Mailing Address - Fax:
Practice Address - Street 1:10995 S HIGHWAY 137
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-4704
Practice Address - Country:US
Practice Address - Phone:918-542-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK283101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)