Provider Demographics
NPI:1801067558
Name:HICKS, GENA D (PHD)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:D
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 W BASELINE RD
Mailing Address - Street 2:STE 101-B
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9307
Mailing Address - Country:US
Mailing Address - Phone:720-414-1315
Mailing Address - Fax:720-899-3160
Practice Address - Street 1:1319 W BASELINE RD
Practice Address - Street 2:STE 101-B
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9307
Practice Address - Country:US
Practice Address - Phone:720-414-1315
Practice Address - Fax:720-899-3160
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003773103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling