MEDICARE: CHERYL D HICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	10181	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194937565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL D HICKS

Provider Business Mailing Address
First Line	:	3003 SOUTH LOOP W
Second Line	:	SUTIE 475
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	713-383-0888
Fax Number	:	713-383-0895

Provider Business Practice Location Address
First Line	:	3003 SOUTH LOOP W
Second Line	:	SUTIE 475
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	713-383-0888
Fax Number	:	713-383-0895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	07/08/2007

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