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NPI Code Detail

MEDICARE: ANGELIA JOYCE HICKS LPC

MEDICARE: ANGELIA JOYCE HICKS LPC
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
1101YP2500XProfessional Counselor77354TX

General Provider Information

NPI Number : 1205488509
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIA JOYCE HICKS LPC
Provider Business Mailing Address
First Line : 11120 PLEASANT WOOD LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76140-6534
Country : US
Telephone Number : 817-449-7161
Fax Number :
Provider Business Practice Location Address
First Line : 5601 BRIDGE ST STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-2355
Country : US
Telephone Number : 469-888-1162
Fax Number : 888-887-9781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2019
Last Update Date : 08/26/2019

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Directions to “ ANGELIA JOYCE HICKS LPC” Practice Location

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