Provider Demographics
NPI:1750596243
Name:HICKEY, RUTH ANNE (LMHC)
Entity type:Individual
Prefix:
First Name:RUTH ANNE
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7423 NORTH ST. SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5213
Mailing Address - Country:US
Mailing Address - Phone:253-582-3992
Mailing Address - Fax:253-582-3992
Practice Address - Street 1:12700 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:253-582-3992
Practice Address - Fax:253-582-3992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093284OtherCIGNA HEALTH PROVIDER#
WA498536OtherVALUE OPTIONS MHS#
WAHI8988OtherREGENCE HEALTH PROVIDER#
WA8907617OtherWA L&I VENDOR#
WA136165OtherMHN PIN #
WA228172 OR 56172OtherMAGELLAN VENDOR#