Mary Lane Mickens

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

19530 Issued in TX

Practice address

5221 N Park Rd
Texarkana, TX 75503-2664

Phone

(903) 791-1051

Fax

(903) 791-1053

NPI assigned

Dec 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Mary Smith Mickens Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 24, 2025 through Oct 24, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Alison Kunefke Mashburn, LPC, PA

  • Professional Counselor
  • Texarkana, TX
  • NPI 1427258664
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265594345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 SHERRY RDG",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755012040",
            "telephone_number": "903-277-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5221 N PARK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032664",
            "telephone_number": "903-791-1051",
            "fax_number": "903-791-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKENS",
        "first_name": "MARY",
        "middle_name": "LANE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "19530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MICKENS",
            "middle_name": "SMITH",
            "prefix": "MRS.",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Metx LLC
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• Michael B. Gilliam
• Anthony Richard Michail, D.M.D.
• Joe Michalls, PHARMD
• Kera Delayne Middleton
• Midsouth Homecare PLLC
• Midsouth Transitions Medical Group
• Milburn S. Haynes, D.D.S., P.a.
• Anna Grace Miller, OT

• Professional Counselor in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.