Provider Demographics
NPI:1104291582
Name:SNOWDEN, LAKELSHA
Entity type:Individual
Prefix:
First Name:LAKELSHA
Middle Name:
Last Name:SNOWDEN
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 1:118 HWY 605
Mailing Address - Street 2:
Mailing Address - City:NEWELLTON
Mailing Address - State:LA
Mailing Address - Zip Code:71357
Mailing Address - Country:US
Mailing Address - Phone:318-467-2399
Mailing Address - Fax:318-467-2400
Practice Address - Street 1:118 HWY 605
Practice Address - Street 2:
Practice Address - City:NEWELLTON
Practice Address - State:LA
Practice Address - Zip Code:71357
Practice Address - Country:US
Practice Address - Phone:318-467-2399
Practice Address - Fax:318-467-2400
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000Medicaid