Provider Demographics
NPI:1487903381
Name:HICKS, WILLIAM LEONARD (LMFT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEONARD
Last Name:HICKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3575
Mailing Address - Country:US
Mailing Address - Phone:763-786-8067
Mailing Address - Fax:763-786-5080
Practice Address - Street 1:7671 CENTRAL AVE NE
Practice Address - Street 2:SUITE 208
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3575
Practice Address - Country:US
Practice Address - Phone:763-786-8067
Practice Address - Fax:763-786-5080
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist