Provider Demographics
NPI:1598942641
Name:GREENWOOD, LASHANTA DENISE
Entity Type:Individual
Prefix:
First Name:LASHANTA
Middle Name:DENISE
Last Name:GREENWOOD
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 1:6107 SPRINGHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1327
Mailing Address - Country:US
Mailing Address - Phone:832-689-6020
Mailing Address - Fax:281-457-5678
Practice Address - Street 1:6107 SPRINGHAVEN DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1327
Practice Address - Country:US
Practice Address - Phone:832-689-6020
Practice Address - Fax:281-457-5678
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
TX66376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251C00000XAgenciesDay Training, Developmentally Disabled Services