Provider Demographics
NPI:1033687421
Name:JOSEPH, LAKISHA DENAY
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:DENAY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 SAGEBRUSH TRL
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3525
Mailing Address - Country:US
Mailing Address - Phone:409-433-2794
Mailing Address - Fax:
Practice Address - Street 1:1402 SAGEBRUSH TRL
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3525
Practice Address - Country:US
Practice Address - Phone:409-433-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health