Provider Demographics
NPI:1124792007
Name:HICKS, KAREEM ABDUL
Entity type:Individual
Prefix:
First Name:KAREEM
Middle Name:ABDUL
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KAREEM
Other - Middle Name:ABDUL
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC 83396
Mailing Address - Street 1:10902 KATY FWY APT 1501
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4914
Mailing Address - Country:US
Mailing Address - Phone:862-230-7819
Mailing Address - Fax:
Practice Address - Street 1:10902 KATY FWY APT 1501
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4914
Practice Address - Country:US
Practice Address - Phone:862-230-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83396101Y00000X
101YM0800X
TX83369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15380039Medicaid
TX439230002Medicaid
TX439230001Medicaid