Provider Demographics
NPI:1518103381
Name:FISHER, LAKEISHA
Entity Type:Individual
Prefix:MS
First Name:LAKEISHA
Middle Name:
Last Name:FISHER
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 1:14602 INSLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-6536
Mailing Address - Country:US
Mailing Address - Phone:832-258-1340
Mailing Address - Fax:713-583-4906
Practice Address - Street 1:5631 GROVETON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3307
Practice Address - Country:US
Practice Address - Phone:832-258-1340
Practice Address - Fax:713-583-4906
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311ZA0620X, 310400000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities