Provider Demographics
NPI:1437614435
Name:FONTENOT, LAKEYSHA RENEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAKEYSHA
Middle Name:RENEE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 S ELIZABETH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1785
Mailing Address - Country:US
Mailing Address - Phone:816-673-4105
Mailing Address - Fax:816-795-1700
Practice Address - Street 1:3737 S ELIZABETH ST STE 200
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1785
Practice Address - Country:US
Practice Address - Phone:816-673-4105
Practice Address - Fax:816-795-1700
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160139551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical