Provider Demographics
NPI:1922357359
Name:LANINGHAM, LACRESHIA (LMT, DOULA)
Entity Type:Individual
Prefix:
First Name:LACRESHIA
Middle Name:
Last Name:LANINGHAM
Suffix:
Gender:F
Credentials:LMT, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16914 SIMSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2210
Mailing Address - Country:US
Mailing Address - Phone:512-925-5688
Mailing Address - Fax:
Practice Address - Street 1:16914 SIMSBROOK DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2210
Practice Address - Country:US
Practice Address - Phone:512-925-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
TXMT116613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist