Provider Demographics
NPI:1679210959
Name:SHEI, LYDIA NTALA
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:NTALA
Last Name:SHEI
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 1:3818 BASTROP ST
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-1402
Mailing Address - Country:US
Mailing Address - Phone:214-664-1907
Mailing Address - Fax:
Practice Address - Street 1:3818 BASTROP ST
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-1402
Practice Address - Country:US
Practice Address - Phone:214-664-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician