Provider Demographics
NPI:1053931014
Name:NICKS, ROBERT CRAIG (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRAIG
Last Name:NICKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2536
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7536
Mailing Address - Country:US
Mailing Address - Phone:903-675-9570
Mailing Address - Fax:903-675-9577
Practice Address - Street 1:700 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3342
Practice Address - Country:US
Practice Address - Phone:903-675-9570
Practice Address - Fax:903-675-9577
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38214103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist