1801563648 NPI number — MRS. LAKESHA TERRELL LINGARD LMFT

Table of content: MRS. LAKESHA TERRELL LINGARD LMFT (NPI 1801563648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801563648 NPI number — MRS. LAKESHA TERRELL LINGARD LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINGARD
Provider First Name:
LAKESHA
Provider Middle Name:
TERRELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWIE
Provider Other First Name:
LAKESHA
Provider Other Middle Name:
TERRELL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801563648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16690 NW 192ND TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32643-0647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-284-0577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16690 NW 192ND TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32643-0647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-284-0577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT3994 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7289568917 . This is a "UNITED HEALTH GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7289568917 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7289568917 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7289568917 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7289568917 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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