Provider Demographics
NPI:1922263359
Name:PRIESTLY, LAKETTRA SHNELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAKETTRA
Middle Name:SHNELL
Last Name:PRIESTLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILD PECAN LOOP
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2573
Mailing Address - Country:US
Mailing Address - Phone:512-644-6977
Mailing Address - Fax:
Practice Address - Street 1:1300 DACY LN
Practice Address - Street 2:STE 235
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4196
Practice Address - Country:US
Practice Address - Phone:512-262-6020
Practice Address - Fax:512-318-2491
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical