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General NPI Number Information
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NPI Number | 1255980496
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Entity Type | Organization
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Legal Business Name | LORI HICKS M.ED., LPC, LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 800 WERNER CT STE 300
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City | CASPER
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State | WY
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Zip | 82601-1325
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Country | US
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Telephone | 307-215-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WERNER CT STE 300
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City | CASPER
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State | WY
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Zip | 82601-1325
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Country | US
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Telephone | 307-215-5650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI HICKS
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Credential | M.ED., LPC
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Telephone | 307-215-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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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 |
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License Number State |
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