Provider Demographics
NPI:1568513422
Name:THERESA HICKS INC PS
Entity Type:Organization
Organization Name:THERESA HICKS INC PS
Other - Org Name:THERESA HICKS DBA NORTHWEST STRESS MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-469-6823
Mailing Address - Street 1:504 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4311
Mailing Address - Country:US
Mailing Address - Phone:509-965-8041
Mailing Address - Fax:509-966-3283
Practice Address - Street 1:504 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4311
Practice Address - Country:US
Practice Address - Phone:509-965-8041
Practice Address - Fax:509-966-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S83785Medicare UPIN
WA8806187Medicare ID - Type Unspecified