Healthcare Provider Details

I. General information

NPI: 1275051682
Provider Name (Legal Business Name): JENNIFER HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2498 E PALM VALLEY BLVD
ROUND ROCK TX
78665-4682
US

IV. Provider business mailing address

PO BOX 97
ROUND ROCK TX
78680-0097
US

V. Phone/Fax

Practice location:
  • Phone: 512-265-6411
  • Fax:
Mailing address:
  • Phone: 512-265-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: