MEDICARE: ANGELA KAYLYN HICKEY MS, MA, 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
1	101YP2500X	Professional Counselor	19527	TX

General Provider Information

NPI Number	:	1225233372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KAYLYN HICKEY MS, MA, LPC

Provider Business Mailing Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	214-890-4071
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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