Mitchell Wayne Hicks, PHD, ABPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-006835 Issued in IL

Practice address

3411 N Kennicott Ave Ste C
Arlington Heights, IL 60004-7813

Phone

(630) 849-8275

Fax

(224) 345-2118

NPI assigned

Dec 14, 2005

Last updated

Mar 8, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in IL, ND2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Crosswinds Center for Personal and Professional Development, PLLCGroup PAC ID 2365790516, 3 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crosswinds Center for Personal and Professional Development, PLLC

  • Clinical Psychologist
  • Arlington Heights, IL
  • NPI 1811412166

  Professional

  Medicare reassignment Care Compare group NPD Authorized official
• North Dakota State Hospital

  • Psychiatric Hospital
  • Jamestown, ND
  • NPI 1649227075
  Medicare reassignment NPD

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299542400000",
    "number": "1093790776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 N KENNICOTT AVE STE C",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600047813",
            "telephone_number": "630-849-8275",
            "fax_number": "224-345-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 N KENNICOTT AVE STE C",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600047813",
            "telephone_number": "630-849-8275",
            "fax_number": "224-345-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "MITCHELL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "PHD, ABPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2011-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180-005185",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-006835",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claudia Angelica Herrera
• Jill Marie Hetzel, PA-C
• Denise Marie Heybrock, LCPC
• Heyer Celestial Paul Devarapalli MD SC
• Janet Hicks, OT
• Avery Higdon, LPC
• Highland Park CVS LLC (CVS Pharmacy #16534)
• Semalie Hila
• Colleen Hile, D.C.
• Catherine Ann Hill, M.A., CCC-A

• Clinical Psychologist in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.