Provider Demographics
NPI:1326365040
Name:LEWIS, LAKEISHA (LPC)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:LEWIS
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 1:1551 N STATE HIGHWAY 161 APT 704
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2885
Mailing Address - Country:US
Mailing Address - Phone:405-777-3817
Mailing Address - Fax:
Practice Address - Street 1:536 SE 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-4402
Practice Address - Country:US
Practice Address - Phone:405-532-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5703101YP2500X
TX80658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200380040BMedicaid