Provider Demographics
NPI:1306523329
Name:HICKS, TEIRA (FULL SPECTRUM DOULA)
Entity type:Individual
Prefix:
First Name:TEIRA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:FULL SPECTRUM DOULA
Other - Prefix:
Other - First Name:LUCE
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FULL SPECTRUM DOULA
Mailing Address - Street 1:528 BLUEBERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3634
Mailing Address - Country:US
Mailing Address - Phone:972-801-7029
Mailing Address - Fax:
Practice Address - Street 1:528 BLUEBERRY HILL LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3634
Practice Address - Country:US
Practice Address - Phone:972-801-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker