Provider Demographics
NPI:1811285679
Name:HICKS, DAN (LPC)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SW SHEVLIN HIXON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3189
Mailing Address - Country:US
Mailing Address - Phone:714-222-4395
Mailing Address - Fax:
Practice Address - Street 1:143 SW SHEVLIN HIXON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3189
Practice Address - Country:US
Practice Address - Phone:714-222-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional