Healthcare Provider Details

I. General information

NPI: 1508628439
Provider Name (Legal Business Name): TRACIE ANNETTE HICKS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 W CLEARWATER AVE STE D242
KENNEWICK WA
99336-2777
US

IV. Provider business mailing address

3311 W CLEARWATER AVE STE D242
KENNEWICK WA
99336-2777
US

V. Phone/Fax

Practice location:
  • Phone: 208-891-4572
  • Fax: 509-396-7838
Mailing address:
  • Phone: 208-891-4572
  • Fax: 509-396-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH70082720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: