Healthcare Provider Details

I. General information

NPI: 1043553191
Provider Name (Legal Business Name): KIRA CAPANO HICKMAN MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRA MAY CAPANO

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CULTURAL PARK BLVD
CAPE CORAL FL
33990-1217
US

IV. Provider business mailing address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-1211
  • Fax:
Mailing address:
  • Phone: 239-332-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9139
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9139
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: