Provider Demographics
NPI:1326736216
Name:HICKS, JACOB LYNN (LPC-A)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2608
Mailing Address - Country:US
Mailing Address - Phone:832-822-3436
Mailing Address - Fax:
Practice Address - Street 1:16710 STONESIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-6514
Practice Address - Country:US
Practice Address - Phone:832-518-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88841103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling