Active NPI
Roger Elliott Hicks III, PHD
- Clinical Psychologist
- North Little Rock, AR
National Provider Identifier
1598071490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2715
- Practice address
- 2200 Fort Roots Dr # 3D
North Little Rock, AR 72114 - Phone
- (501) 257-3925
- NPI assigned
- Aug 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | 2715 | KS | Primary |
Addresses
Primary practice location
2200 Fort Roots Dr # 3D
North Little Rock, AR 72114
Mailing address
2200 Fort Roots Dr # 3D
North Little Rock, AR 72114-1709
Phone (501) 257-3925
Other practice location 1
4301 W Markham St
slot 589
Little Rock, AR 72205-7101
Phone (312) 747-8974
Other practice location 2
4301 W Markham St
slot 589
Little Rock, AR 72205-7101
Phone (312) 747-8974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2715 | KS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569369600000",
"number": "1598071490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR # 3D",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-3925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR # 3D",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "72114",
"telephone_number": "501-257-3925"
}
],
"practiceLocations": [
{
"address_1": "4301 W Markham St",
"address_2": "slot 589",
"address_purpose": "LOCATION",
"city": "Little Rock",
"state": "AR",
"postal_code": "722057101",
"country_code": "US",
"telephone_number": "312-747-8974",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4301 W Markham St",
"address_2": "slot 589",
"address_purpose": "LOCATION",
"city": "Little Rock",
"state": "AR",
"postal_code": "722057101",
"country_code": "US",
"telephone_number": "312-747-8974",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HICKS",
"first_name": "ROGER",
"middle_name": "ELLIOTT",
"name_suffix": "III",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-30",
"last_updated": "2019-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "2715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
- Alisha Dawn Herring, M.S. CCC-SLP
- Shalae N Hesselbein, LCSW
- Gerald Mark Heulitt, M.D.
- James Monroe Hickman II, LCSW
- Evan Hicks, MD
- Anne M Hiegel, RN, APRN
- Erica Henderson Hiett, MD
- Highlands of North Little Rock John Ashley Holdings LLC
- Highlands of North Little Rock John Ashley, LLC
- Beverly Hunt Hildebrand, PH.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.