MEDICARE: JACOB LYNN HICKS LPC-A

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	103TC1900X	Counseling Psychologist	88841	TX

General Provider Information

NPI Number	:	1326736216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB LYNN HICKS LPC-A

Provider Business Mailing Address
First Line	:	6701 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2608
Country	:	US
Telephone Number	:	832-822-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	16710 STONESIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-6514
Country	:	US
Telephone Number	:	832-518-7933
Fax Number	:

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

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	04/27/2023

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