MEDICARE: ANNE CLAIRE HICKMAN WOODS 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	101YM0800X	Mental Health Counselor	74761	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74761	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1528617511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE CLAIRE HICKMAN WOODS LPC

Provider Business Mailing Address
First Line	:	4809 GERONA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4914
Country	:	US
Telephone Number	:	512-680-6398
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 GERONA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4914
Country	:	US
Telephone Number	:	512-680-6398
Fax Number	:

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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