MEDICARE: ABBY JO HAWKINS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14688	TX
2	101YP2500X	Professional Counselor	79417	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14688	OTHER	TX	LCDC
2	14588719	OTHER	TX	CAQH
3	79417	OTHER	TX	LPC

General Provider Information

NPI Number	:	1548807092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY JO HAWKINS LPC

Provider Business Mailing Address
First Line	:	215 HORSEMANS DR
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-7734
Country	:	US
Telephone Number	:	469-346-9384
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 HEBRON PKWY STE 1101
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-5147
Country	:	US
Telephone Number	:	469-444-2244
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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Directions to “ ABBY JO HAWKINS LPC” Practice Location

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