Basic Information
| Provider Information | |||||||||
| NPI: | 1174035133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICKMAN | ||||||||
| FirstName: | LOREN | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 NEW HARTFORD RD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706845034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2017 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 253354 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.