Provider Demographics
NPI:1578348470
Name:HICKS, DALTON (RBT)
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TUTOR LN STE 107
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7295
Mailing Address - Country:US
Mailing Address - Phone:812-602-1038
Mailing Address - Fax:812-602-1048
Practice Address - Street 1:900 TUTOR LN STE 107
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7295
Practice Address - Country:US
Practice Address - Phone:812-602-1038
Practice Address - Fax:812-602-1048
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-237240106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician