Provider Demographics
NPI:1790594364
Name:HILL, LAKISHA (DOCTOR OF PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:DOCTOR OF PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 SHAVANO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-4009
Mailing Address - Country:US
Mailing Address - Phone:805-616-8348
Mailing Address - Fax:
Practice Address - Street 1:1550 W ROSEDALE ST STE 518
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7403
Practice Address - Country:US
Practice Address - Phone:817-348-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40503103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist