Provider Demographics
NPI:1770134637
Name:GOMEZ, LAKISHA (LMHC)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6008
Mailing Address - Country:US
Mailing Address - Phone:788-628-7689
Mailing Address - Fax:
Practice Address - Street 1:11260 RANCH CREEK TER APT 112
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4032
Practice Address - Country:US
Practice Address - Phone:786-287-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health