Provider Demographics
NPI:1568356343
Name:HICKINBOTHAM, MEGAN ELENA (RBT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELENA
Last Name:HICKINBOTHAM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELENA
Other - Last Name:HICKINBOTHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:239 CENTER ST UNIT 223
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-0003
Mailing Address - Country:US
Mailing Address - Phone:210-701-4074
Mailing Address - Fax:
Practice Address - Street 1:11206 SILVER ROSE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4482
Practice Address - Country:US
Practice Address - Phone:501-743-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician