Provider Demographics
NPI:1639607450
Name:LOWERY, LAKETTA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LAKETTA
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESTFORK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70827-2070
Mailing Address - Country:US
Mailing Address - Phone:225-380-3752
Mailing Address - Fax:
Practice Address - Street 1:2900 WESTFORK DR STE 401
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0004
Practice Address - Country:US
Practice Address - Phone:225-380-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X, 171M00000X
LA7095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator