Provider Demographics
NPI:1124436035
Name:DICKSON, CODY WILLIAM (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:WILLIAM
Last Name:DICKSON
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 IRONTON AVE APT 3201
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3783
Mailing Address - Country:US
Mailing Address - Phone:806-252-6633
Mailing Address - Fax:
Practice Address - Street 1:3805 22ND ST STE 1C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1142
Practice Address - Country:US
Practice Address - Phone:806-252-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5222101YM0800X
TX69897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5222OtherNEBRASKA DHHS LICENSURE UNIT
TX338488501Medicaid
TX69897OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS