Provider Demographics
NPI:1730297334
Name:HICKEY, MARY MARGARET (LPC)
Entity Type:Individual
Prefix:
First Name:MARY MARGARET
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:8407 SW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3423
Mailing Address - Country:US
Mailing Address - Phone:503-568-1846
Mailing Address - Fax:
Practice Address - Street 1:8407 SW 46TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3423
Practice Address - Country:US
Practice Address - Phone:503-568-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6943101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health