Provider Demographics
NPI:1952884132
Name:HOWARD, TAKISHA A
Entity Type:Individual
Prefix:
First Name:TAKISHA
Middle Name:A
Last Name:HOWARD
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 1:3400 MCMILLEN RD APT 421
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7714
Mailing Address - Country:US
Mailing Address - Phone:469-688-3003
Mailing Address - Fax:
Practice Address - Street 1:12959 JUPITER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5223
Practice Address - Country:US
Practice Address - Phone:214-221-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional