Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CORPHQ-144-072008S | CA |
Y | 103G00000X | Clinical Psychologist | PSY 22736 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 22736 | CA |
NPI | 1528121712 |
---|---|
Provider Name | Dr. Frederic Hicks Jones |
First Address | Burney, CA 96013-4253 |
Second Address | Burney, CA 96013-4386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 05/01/2013 |