Provider Demographics
NPI:1417636184
Name:JEMISON, LAKEEA
Entity type:Individual
Prefix:
First Name:LAKEEA
Middle Name:
Last Name:JEMISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 E 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4491
Mailing Address - Country:US
Mailing Address - Phone:512-804-3380
Mailing Address - Fax:
Practice Address - Street 1:1631 E 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4491
Practice Address - Country:US
Practice Address - Phone:512-804-3380
Practice Address - Fax:512-472-5857
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)