Provider Demographics
NPI:1922177328
Name:HICKS, JILL KATHRYN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:KATHRYN
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N 3RD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1691
Mailing Address - Country:US
Mailing Address - Phone:208-265-1090
Mailing Address - Fax:208-265-3756
Practice Address - Street 1:606 N 3RD AVE STE 203
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1691
Practice Address - Country:US
Practice Address - Phone:208-265-1090
Practice Address - Fax:208-265-3756
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health