Healthcare Provider Details

I. General information

NPI: 1255980496
Provider Name (Legal Business Name): LORI HICKS M.ED., LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WERNER CT STE 300
CASPER WY
82601-1325
US

IV. Provider business mailing address

800 WERNER CT STE 300
CASPER WY
82601-1325
US

V. Phone/Fax

Practice location:
  • Phone: 307-215-5650
  • Fax:
Mailing address:
  • Phone: 307-215-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORI HICKS
Title or Position: OWNER
Credential: M.ED., LPC
Phone: 307-215-5650