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General NPI Number Information
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NPI Number | 1124436035
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Entity Type | Individual
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Provider Name | CODY WILLIAM DICKSON PHD, LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 3805 22ND ST STE 1C
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City | LUBBOCK
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State | TX
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Zip | 79410-1142
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Country | US
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Telephone | 806-252-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 4510 IRONTON AVE APT 3201
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City | LUBBOCK
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State | TX
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Zip | 79407-3783
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Country | US
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Telephone | 806-252-6633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5222
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69897
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License Number State | TX
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