Provider Demographics
NPI:1669949558
Name:SCOTT, LAKIESHA
Entity type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 1ST ST APT 315
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3405
Mailing Address - Country:US
Mailing Address - Phone:323-977-0127
Mailing Address - Fax:
Practice Address - Street 1:2200 1ST ST APT 315
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3405
Practice Address - Country:US
Practice Address - Phone:323-977-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician