Provider Demographics
NPI:1851469860
Name:HICKAM, ANDREW RICHARD III (LPC, LPA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RICHARD
Last Name:HICKAM
Suffix:III
Gender:M
Credentials:LPC, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1932
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79721-1932
Mailing Address - Country:US
Mailing Address - Phone:432-263-3868
Mailing Address - Fax:432-263-3402
Practice Address - Street 1:500 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2644
Practice Address - Country:US
Practice Address - Phone:432-263-3868
Practice Address - Fax:432-263-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 16145101YM0800X
TXLPA 15197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4163LCOtherBLUE CROSS BLUE SHIELD
TX0959942-02Medicaid