Provider Demographics
NPI:1528802907
Name:POWELL, LASHEDRA DESIREE
Entity type:Individual
Prefix:
First Name:LASHEDRA
Middle Name:DESIREE
Last Name:POWELL
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 1:23415 MOUNTAIN ASHTREE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2090
Mailing Address - Country:US
Mailing Address - Phone:936-229-1183
Mailing Address - Fax:
Practice Address - Street 1:23415 MOUNTAIN ASHTREE WAY
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2090
Practice Address - Country:US
Practice Address - Phone:936-229-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician