MEDICARE: ELLA HICKS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1437728870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA HICKS

Provider Business Mailing Address
First Line	:	507 IVANHOE WAY
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4740
Country	:	US
Telephone Number	:	407-894-1708
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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Directions to “ ELLA HICKS ” Practice Location

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