=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326162421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXIE HICKS COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 E 20TH ST LEXIE HICKS COUNSELING CENTER
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 E 20TH ST LEXIE HICKS COUNSELING CENTER
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. SHELLEY R. CORUM
-----------------------------------------------------
Credential | M.D.A.
-----------------------------------------------------
Telephone | 270-926-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | KY-0026
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------