Provider Demographics
NPI:1881030468
Name:HICKS, MARIAN BLEDSOE (MED LPC LMFT PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:BLEDSOE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MED LPC LMFT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX #563
Mailing Address - Street 2:690 AN CO RD #360
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803
Mailing Address - Country:US
Mailing Address - Phone:903-723-2451
Mailing Address - Fax:903-723-2451
Practice Address - Street 1:690 ANDERSON CO ROAD # 360
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803-0000
Practice Address - Country:US
Practice Address - Phone:903-723-2451
Practice Address - Fax:903-723-2451
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11657101YP2500X
TX3397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist