Provider Demographics
NPI:1306208459
Name:BERRY, LAMENCIA
Entity Type:Individual
Prefix:
First Name:LAMENCIA
Middle Name:
Last Name:BERRY
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 1:3424 FRANKFORD AVE APT 16F
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3704
Mailing Address - Country:US
Mailing Address - Phone:512-698-6768
Mailing Address - Fax:
Practice Address - Street 1:3424 FRANKFORD AVE APT 16F
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3704
Practice Address - Country:US
Practice Address - Phone:512-698-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional