Provider Demographics
NPI:1790873982
Name:HICKMAN, ROBBIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632
Mailing Address - Country:US
Mailing Address - Phone:712-542-3501
Mailing Address - Fax:712-542-4725
Practice Address - Street 1:215 E WASHINGTON
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632
Practice Address - Country:US
Practice Address - Phone:712-542-3501
Practice Address - Fax:712-542-4725
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6576020OtherSD MEDICAID
245687OtherMIDLANDS CHOICE
MO490124599Medicaid
IA783456000Medicaid