Provider Demographics
NPI:1326162421
Name:LEXIE HICKS COUNSELING CENTER
Entity type:Organization
Organization Name:LEXIE HICKS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORUM
Authorized Official - Suffix:
Authorized Official - Credentials:MDA
Authorized Official - Phone:270-926-6900
Mailing Address - Street 1:120 E 20TH ST
Mailing Address - Street 2:LEXIE HICKS COUNSELING CENTER
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-926-6900
Mailing Address - Fax:
Practice Address - Street 1:120 E 20TH ST
Practice Address - Street 2:LEXIE HICKS COUNSELING CENTER
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-926-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health