Provider Demographics
NPI:1386855187
Name:CARRELL, LAKETIA W (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAKETIA
Middle Name:W
Last Name:CARRELL
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 1:12064 JAMESBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7810
Mailing Address - Country:US
Mailing Address - Phone:314-355-7228
Mailing Address - Fax:
Practice Address - Street 1:12064 JAMESBOROUGH DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7810
Practice Address - Country:US
Practice Address - Phone:314-355-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002382101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor