Provider Demographics
NPI:1194937565
Name:HICKS, CHERYL D
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 SOUTH LOOP W
Mailing Address - Street 2:SUTIE 475
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1301
Mailing Address - Country:US
Mailing Address - Phone:713-383-0888
Mailing Address - Fax:713-383-0895
Practice Address - Street 1:3003 SOUTH LOOP W
Practice Address - Street 2:SUTIE 475
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1301
Practice Address - Country:US
Practice Address - Phone:713-383-0888
Practice Address - Fax:713-383-0895
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10181101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157440201Medicaid