Provider Demographics
NPI:1447729520
Name:HICKS, LEAH PAMELA (LPC-INTERN, ASOTP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:PAMELA
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC-INTERN, ASOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CECIL DR
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4002
Mailing Address - Country:US
Mailing Address - Phone:409-330-3980
Mailing Address - Fax:
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4111
Practice Address - Country:US
Practice Address - Phone:409-600-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional