Provider Demographics
NPI:1205013687
Name:HICKOK, ELISABETH EGAN (LPC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:EGAN
Last Name:HICKOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SUDESTE PL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9380
Mailing Address - Country:US
Mailing Address - Phone:512-516-1543
Mailing Address - Fax:505-983-2167
Practice Address - Street 1:20 SUDESTE PL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9380
Practice Address - Country:US
Practice Address - Phone:512-516-1543
Practice Address - Fax:505-983-2167
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional