Provider Demographics
NPI:1134754823
Name:LAMAR, AKILAH (PSYD)
Entity type:Individual
Prefix:
First Name:AKILAH
Middle Name:
Last Name:LAMAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17381 FERRIS ST APT 207
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-8329
Mailing Address - Country:US
Mailing Address - Phone:856-308-2966
Mailing Address - Fax:
Practice Address - Street 1:4490 REFORMATORY RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9001
Practice Address - Country:US
Practice Address - Phone:765-778-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99095601A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical