Provider Demographics
NPI:1811685704
Name:LAVALLAIS, CANDIS JAI (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:CANDIS
Middle Name:JAI
Last Name:LAVALLAIS
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-3315
Mailing Address - Country:US
Mailing Address - Phone:317-435-7184
Mailing Address - Fax:
Practice Address - Street 1:6714 KESWICK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-3315
Practice Address - Country:US
Practice Address - Phone:317-435-7184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004495A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92586OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL