Provider Demographics
NPI:1134411036
Name:HICKERSON, PAUL T (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:HICKERSON
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-9998
Mailing Address - Country:US
Mailing Address - Phone:479-692-1208
Mailing Address - Fax:866-538-2772
Practice Address - Street 1:106 E MAIN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5128
Practice Address - Country:US
Practice Address - Phone:479-692-1208
Practice Address - Fax:866-538-2772
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1408057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health