Provider Demographics
NPI:1225231343
Name:NICOLAS, LAKANA S (MHRS)
Entity Type:Individual
Prefix:
First Name:LAKANA
Middle Name:S
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:MHRS
Other - Prefix:
Other - First Name:LAKANA
Other - Middle Name:
Other - Last Name:PHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5900 SEPULVEDA BLVD
Mailing Address - Street 2:#425
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2511
Mailing Address - Country:US
Mailing Address - Phone:818-267-1100
Mailing Address - Fax:818-267-1199
Practice Address - Street 1:2810 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4321
Practice Address - Country:US
Practice Address - Phone:818-267-1100
Practice Address - Fax:323-807-4331
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW32721041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical