Healthcare Provider Details

I. General information

NPI: 1598611667
Provider Name (Legal Business Name): KAREN LAFAY PREACELY HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 CATALPA WAY
CARSON CA
90746-7495
US

IV. Provider business mailing address

17609 CATALPA WAY
CARSON CA
90746-7495
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-2425
  • Fax:
Mailing address:
  • Phone: 310-795-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC14146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: