Provider Demographics
NPI:1285313411
Name:WICKER, LYEZA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:LYEZA
Middle Name:ANN
Last Name:WICKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 DORAL ROSE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5185
Mailing Address - Country:US
Mailing Address - Phone:281-772-5784
Mailing Address - Fax:
Practice Address - Street 1:3200 SOUTHWEST FWY STE 2100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7525
Practice Address - Country:US
Practice Address - Phone:833-208-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109269104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker