Provider Demographics
NPI:1477721249
Name:HICKLING, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HICKLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-7409
Mailing Address - Country:US
Mailing Address - Phone:865-376-2296
Mailing Address - Fax:865-376-0369
Practice Address - Street 1:183 FIDDLERS LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4020
Practice Address - Country:US
Practice Address - Phone:865-376-2296
Practice Address - Fax:865-376-0369
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011345103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist