Provider Demographics
NPI:1215584594
Name:LACKEY, SHARON (LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 PORT NECHES AVE OFC A
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-3939
Mailing Address - Country:US
Mailing Address - Phone:409-344-9155
Mailing Address - Fax:866-883-6818
Practice Address - Street 1:2420 PORT NECHES AVE OFC A
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-3939
Practice Address - Country:US
Practice Address - Phone:409-853-4699
Practice Address - Fax:866-883-6818
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81252101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81252OtherLPC