MEDICARE: ELISABETH EGAN HICKOK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CCMH0209991	NM
2	101YP2500X	Professional Counselor	81544	TX

General Provider Information

NPI Number	:	1205013687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH EGAN HICKOK LPC

Provider Business Mailing Address
First Line	:	20 SUDESTE PL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-9380
Country	:	US
Telephone Number	:	512-516-1543
Fax Number	:	505-983-2167

Provider Business Practice Location Address
First Line	:	20 SUDESTE PL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-9380
Country	:	US
Telephone Number	:	512-516-1543
Fax Number	:	505-983-2167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	02/07/2026

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