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VIVIAN HICKS MA
NPI 1053712711
Counselor - Mental Health in Jamestown, KY

Active since September 11, 2014Opted out of Medicare · through Mar 6, 2028
79 LILLY CREEK LN, JAMESTOWN, KY 42629(253) 625-0141(253) 302-5406 Get Directions Write a Review

NPPES record last updated: June 12, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 12, 2023, Jul 5, 2022, Apr 8, 2020 and 1 more (4 updates tracked since 2016).

About Vivian Hicks Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VIVIAN HICKS MA (NPI 1053712711) is an individual mental health provider in Jamestown, Kentucky, licensed in Washington (MC60587450) and active in the NPI registry since September 2014. She has opted out of Medicare through March 6, 2028.

NPPES Registry Identity

NPI1053712711
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameVIVIAN HICKSCredential: MA
Location Address79 LILLY CREEK LNJamestown, KY 42629-7924
Mailing Address79 Lilly Creek LnJamestown, KY 42629-7924 · (253) 625-0141 · Fax (253) 302-5406
Phone(253) 625-0141
Fax(253) 302-5406
Sole ProprietorNo
Enumeration DateSeptember 11, 2014
Last NPPES UpdateJune 12, 20234 updates tracked since enumeration
NPPES CertifiedJune 12, 2023
✔ NPI 1053712711 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Licenses✔ Licensed in WA · MC60587450✔ Licensed in KY · 275012
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License CO 60457984 (WA)
79 LILLY CREEK LN, Jamestown, KY 42629
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Other Names 1

Former Name (1)Vivian Ilene Rivera Ma, Lmhca

Other Identifiers 5

OtherMC60587450WA · Washington State Lmhca
OtherLH60776174WA · Mental Health Counselor License
Other4397AL · Alabama State License
OtherCO 60457984WA · Washington State Cdpt
Other275012KY · Kentucky Lpcc License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Vivian Hicks Ma has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 6, 2024 through March 6, 2028.

Opt-Out Effective DateMarch 6, 2024
Opt-Out In Effect ThroughMarch 6, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vivian Hicks's NPI number?

The NPI number for Vivian Hicks is 1053712711. It was assigned to this individual provider in the NPPES registry on September 11, 2014. The provider is also known as Vivian Ilene Rivera Ma, Lmhca.

Where is Vivian Hicks located?

Vivian Hicks practices at 79 Lilly Creek Ln, Jamestown, KY 42629. The listed phone number is (253) 625-0141.

What is Vivian Hicks's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Vivian Hicks enrolled in Medicare?

No. Vivian Hicks has opted out of Medicare through March 6, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Vivian Hicks was last updated on June 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.