Individual
GREGORY HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
242 N MAGDALEN ST, SAN ANGELO, TX 76903-5434
(325) 944-2561
Mailing address
242 N MAGDALEN ST, SAN ANGELO, TX 76903-5434
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
75513
TX
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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