Provider Demographics
NPI:1215944327
Name:GLICK, FELICIA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:M
Last Name:GLICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-2048
Mailing Address - Country:US
Mailing Address - Phone:949-835-5329
Mailing Address - Fax:
Practice Address - Street 1:111 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-2048
Practice Address - Country:US
Practice Address - Phone:949-835-5329
Practice Address - Fax:888-393-7595
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA972001041C0700X, 1041C0700X
TX1058941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633897OtherBCBS NUMBER
IL088475OtherMHN PROVIDER NUMBER
ILK03449Medicare UPIN
IL207844Medicare UPIN