Provider Demographics
NPI:1831261213
Name:VICK, JOANN JODY (LCSW LMFT LPC (MSW))
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:JODY
Last Name:VICK
Suffix:
Gender:F
Credentials:LCSW LMFT LPC (MSW)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 KELLERTOU LN.
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:281-367-2337
Mailing Address - Fax:281-367-7620
Practice Address - Street 1:2441 HIGH TIMBERS
Practice Address - Street 2:STE. 100
Practice Address - City:WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-367-2337
Practice Address - Fax:281-367-7620
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1450101YP2500X
TX007011041C0700X, 104100000X
TX1915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S96KMedicare ID - Type Unspecified
TX613582Medicare PIN