Provider Demographics
NPI:1396722039
Name:SICARD, AUGUSTIN (LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:AUGUSTIN
Middle Name:
Last Name:SICARD
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W THEO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1849
Mailing Address - Country:US
Mailing Address - Phone:210-317-8854
Mailing Address - Fax:210-922-6633
Practice Address - Street 1:1007 W THEO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1849
Practice Address - Country:US
Practice Address - Phone:210-317-8854
Practice Address - Fax:210-922-6633
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025732102Medicaid
TX83542LOtherBLUE CROSS BLUE SHIELD