MEDICARE: DANIELLE LICO 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
2	101YS0200X	School Counselor		TX

General Provider Information

NPI Number	:	1720523517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LICO LPC

Provider Business Mailing Address
First Line	:	2600 LONE STAR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 LONE STAR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6336
Country	:	US
Telephone Number	:	214-698-2200
Fax Number	:

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	04/07/2026

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Directions to “ DANIELLE LICO LPC” Practice Location

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