Provider Demographics
NPI:1508479601
Name:HICKS, AMYLYNNE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMYLYNNE
Middle Name:LOUISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMYLYNNE
Other - Middle Name:
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2204
Mailing Address - Country:US
Mailing Address - Phone:270-796-2012
Mailing Address - Fax:
Practice Address - Street 1:918 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2204
Practice Address - Country:US
Practice Address - Phone:270-796-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2551381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical