Provider Demographics
NPI:1154057065
Name:ELLIOTT, LAKITA
Entity Type:Individual
Prefix:
First Name:LAKITA
Middle Name:
Last Name:ELLIOTT
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 1:6786 N PARAMOUNT BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2084
Mailing Address - Country:US
Mailing Address - Phone:562-742-6653
Mailing Address - Fax:
Practice Address - Street 1:6786 N PARAMOUNT BLVD APT B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2084
Practice Address - Country:US
Practice Address - Phone:562-742-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician