Provider Demographics
NPI:1720187305
Name:HICKMAN, JULIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 REYNOLDS CT
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:98602
Mailing Address - Country:US
Mailing Address - Phone:512-321-7334
Mailing Address - Fax:512-321-3580
Practice Address - Street 1:909 PECAN
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-321-7334
Practice Address - Fax:512-321-3580
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOG22CMedicare ID - Type Unspecified