Provider Demographics
NPI:1851164586
Name:INELUS, LAKISHA
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:
Last Name:INELUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAKISHA
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MURRAY
Mailing Address - Street 1:12239 SE BUSH ST UNIT 89
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3494
Mailing Address - Country:US
Mailing Address - Phone:971-401-4069
Mailing Address - Fax:
Practice Address - Street 1:4101 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4617
Practice Address - Country:US
Practice Address - Phone:503-666-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health