Provider Demographics
NPI:1760960025
Name:JOHNSON, LAKESHA SHERRE
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:SHERRE
Last Name:JOHNSON
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 1:2101 CRAWFORD ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8941
Mailing Address - Country:US
Mailing Address - Phone:302-990-8126
Mailing Address - Fax:
Practice Address - Street 1:2101 CRAWFORD ST STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8941
Practice Address - Country:US
Practice Address - Phone:302-990-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36409365Medicaid