Provider Demographics
NPI:1932435724
Name:WICKS, SUSAN EILEEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EILEEN
Last Name:WICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 WICKENBURG DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3126
Mailing Address - Country:US
Mailing Address - Phone:281-450-0546
Mailing Address - Fax:
Practice Address - Street 1:9619 WICKENBURG DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3126
Practice Address - Country:US
Practice Address - Phone:281-450-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional