Active NPI
Susan Elaine Bicknell, LPC
- Professional Counselor
- Fort Worth, TX
National Provider Identifier
1205424488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 74837
- Practice address
- 3301 West Fwy Ste 105
Fort Worth, TX 76107-5767 - Phone
- (817) 812-3021
- Fax
- (817) 812-3035
- NPI assigned
- Jan 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 74837 | TX | Primary |
Addresses
Primary practice location
3301 West Fwy Ste 105
Fort Worth, TX 76107-5767
Mailing address
905 Ascension Dr
Hurst, TX 76053-7113
Phone (817) 282-0110
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.homesteadhope.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74837 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Homestead Hope Counseling Services, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1205424488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 ASCENSION DR",
"city": "HURST",
"state": "TX",
"postal_code": "760537113",
"telephone_number": "817-282-0110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 WEST FWY STE 105",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761075767",
"telephone_number": "817-812-3021",
"fax_number": "817-812-3035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BICKNELL",
"first_name": "SUSAN",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-04",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "74837",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.homesteadhope.org",
"affiliation": "N",
"address_1": "3301 West Fwy Ste 105",
"city": "Fort Worth",
"state": "TX",
"country_code": "US",
"postal_code": "761075767",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.