Provider Demographics
NPI:1902338106
Name:HICKONBOTTOM, JAMES ROBERT JR (MAPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:HICKONBOTTOM
Suffix:JR
Gender:M
Credentials:MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 FOREMASTER LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-1008
Mailing Address - Country:US
Mailing Address - Phone:702-229-6117
Mailing Address - Fax:
Practice Address - Street 1:5717 GIPSY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3663
Practice Address - Country:US
Practice Address - Phone:725-263-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health