MEDICARE: LAKESHA WHITLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1932030467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA WHITLEY

Provider Business Mailing Address
First Line	:	608 SPICEWOOD DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-1497
Country	:	US
Telephone Number	:	469-337-0040
Fax Number	:	469-337-0040

Provider Business Practice Location Address
First Line	:	608 SPICEWOOD DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-1497
Country	:	US
Telephone Number	:	469-337-0040
Fax Number	:	469-337-0040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ LAKESHA WHITLEY ” Practice Location

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