Provider Demographics
NPI:1700663374
Name:HICKS, BRIAN ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:HICKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:ARTHUR
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-1502
Mailing Address - Country:US
Mailing Address - Phone:469-964-0423
Mailing Address - Fax:
Practice Address - Street 1:1720 OAK VILLAGE BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7952
Practice Address - Country:US
Practice Address - Phone:469-964-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty