Provider Demographics
NPI:1639186885
Name:FICKES, ROBERT EUGENE JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EUGENE
Last Name:FICKES
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MOSSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4718
Mailing Address - Country:US
Mailing Address - Phone:217-725-5623
Mailing Address - Fax:217-528-1989
Practice Address - Street 1:925 S SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2784
Practice Address - Country:US
Practice Address - Phone:217-528-1988
Practice Address - Fax:217-528-1989
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional