Susan Elaine Hickman, PHD, PSYD
Individual provider Active NPI Clinical Psychologist · Red Bank, TN
NPI 1174710396 · NPPES record last updated Dec 31, 2019
Key facts
- NPI
- 1174710396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- P0000002807 (TN)
- Practice address
- 3212 Dayton Blvd Ste B
Red Bank, TN 37415-5046 - Phone
- (423) 508-8200
- NPI assigned
- Oct 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0000002807 | TN | MD | Clinical Psychologist |
| 2807 | TN | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P0000002807 | TN | Yes |
Addresses
Primary practice location
3212 Dayton Blvd Ste B
Red Bank, TN 37415-5046
Mailing address
3212 Dayton Blvd Ste B
Red Bank, TN 37415-5046
Phone (423) 508-8200
Other providers in Red Bank, TN
- Lindsay Evans
- Fast Pace Medical Clinic PLLC
- Sarah E Grissom
- Randy Scott Hall
- Kayla Turner Hickman
- Lindsay Erin Johnson
- K-VA-T Food Stores Inc
- Colleen Keough
- Jennifer Suzanne Kirk
- Robert Taylor Kokoszka
All providers in Red Bank, TN · Clinical Psychologist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.