Provider Demographics
NPI:1740431071
Name:LITICKER, TERRI C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:C
Last Name:LITICKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PITTSBURG LNDG
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4606
Mailing Address - Country:US
Mailing Address - Phone:972-222-0204
Mailing Address - Fax:972-222-0204
Practice Address - Street 1:2300 PITTSBURG LNDG
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4606
Practice Address - Country:US
Practice Address - Phone:972-222-0204
Practice Address - Fax:972-222-0204
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical