Provider Demographics
NPI:1508490673
Name:HICKEY, TERRENCE (MS)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 E SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8280
Mailing Address - Country:US
Mailing Address - Phone:520-237-4435
Mailing Address - Fax:
Practice Address - Street 1:11235 E SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8280
Practice Address - Country:US
Practice Address - Phone:520-237-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC0859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)