Doctor Name: | DR. SCOTT OWEN HICKMAN |
NPI Number: | 1093927667 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD |
License Number: | 33374 |
Business Practice Address: | 1664 Keller Pkwy Ste 103 Keller, TX - 762483760 |
Business Phone Number: | 8172534686 |
Business Fax Number: | |
Mailing Address: | 1664 Keller Pkwy Ste 103, KELLER |
State: | TX |
Postal Code: | 762483760 |
Phone Number: | 8172534686 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 33374 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |