MEDICARE: ANGELA HICKS

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

General Provider Information

NPI Number	:	1871903146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA HICKS

Provider Business Mailing Address
First Line	:	1417 W MORRIS AVE
Second Line	:	SUITE E
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	985-542-9949
Fax Number	:	985-542-9946

Provider Business Practice Location Address
First Line	:	1417 W MORRIS AVE
Second Line	:	SUITE E
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	985-542-9949
Fax Number	:	985-542-9946

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

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	03/07/2017

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Directions to “ ANGELA HICKS ” Practice Location

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