Provider Demographics
NPI:1134750300
Name:YOUNG-ARIYO, LAKETRA S (MA, LPC)
Entity type:Individual
Prefix:
First Name:LAKETRA
Middle Name:S
Last Name:YOUNG-ARIYO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:LAKETRA
Other - Middle Name:SHANEL
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2111 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5007
Mailing Address - Country:US
Mailing Address - Phone:214-991-4000
Mailing Address - Fax:
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3614
Practice Address - Country:US
Practice Address - Phone:972-534-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health