Provider Demographics
NPI:1124619978
Name:SUE HICKS LLC
Entity type:Organization
Organization Name:SUE HICKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-740-0391
Mailing Address - Street 1:5524 S CAPER PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6929
Mailing Address - Country:US
Mailing Address - Phone:208-740-0391
Mailing Address - Fax:
Practice Address - Street 1:4477 W EMERALD ST STE C275
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2078
Practice Address - Country:US
Practice Address - Phone:208-740-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)