Samuel Hickson, PHD, LCSW, NPT-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11811-C Issued in NV

Practice address

2480 W Horizon Ridge Pkwy Ste 100
Henderson, NV 89052-2719

Phone

(702) 608-4220

NPI assigned

Jan 16, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bergdale and Hall LLCGroup PAC ID 5698076602, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bergdale & Hall, LLC

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1972814630
  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  NV

  Medicare reassignment NPD
• Bergdale & Hall, LLC

  • Child & Adolescent Psychiatry Physician
  • Las Vegas, NV
  • NPI 1346609203
  NPD
• Illuminated Path LLC

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1689138877
  NPD (past)
• Infinite Wellness and Recovery LLC

  • Mental Health Counselor
  • Las Vegas, NV
  • NPI 1326768672
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1083365589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6879 W CHARLESTON BLVD STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891171672",
            "telephone_number": "702-608-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 W HORIZON RIDGE PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522719",
            "telephone_number": "702-608-4220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6885 W Charleston Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891171600",
            "country_code": "US",
            "telephone_number": "702-608-4220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKSON",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW, NPT-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-16",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09932242",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "11811-C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C019769",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NEVADA BOARD OF SOCIAL WORK",
            "identifier": "11811-C",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://serenitysupportservices.com/",
            "affiliation": "N",
            "address_1": "6879 W Charleston Blvd Ste A",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891171672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan Hickman
• Robbin Ann Hickman, PT, DSC, PCS
• David Hicks
• Dijannia Hicks
• Glammoris Hicks
• Mason Hiedeman
• Kelsey Higa, DMD
• Cory Carter Higbee, PT
• Daniel Higdon
• Zachary Higginbotham

• Clinical Social Worker in Henderson, NV
• Providers in Henderson, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.