1871655563 NPI number — MS. BRENDA SUZANNE SIKKEMA-SYKES MS, LPC

Table of content: MS. BRENDA SUZANNE SIKKEMA-SYKES MS, LPC (NPI 1871655563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871655563 NPI number — MS. BRENDA SUZANNE SIKKEMA-SYKES MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIKKEMA-SYKES
Provider First Name:
BRENDA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871655563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
874 SANDY MOUNTAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE BEACH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78643-9257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-956-9650
Provider Business Mailing Address Fax Number:
325-388-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 B 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-956-9650
Provider Business Practice Location Address Fax Number:
325-388-5283
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  13722 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 028553801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10072026 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7352LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".