Healthcare Provider Details

I. General information

NPI: 1710546379
Provider Name (Legal Business Name): LAKERA DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 13301
MAUMELLE AR
72113-0301
US

IV. Provider business mailing address

PO BOX 13301
MAUMELLE AR
72113-0301
US

V. Phone/Fax

Practice location:
  • Phone: 501-773-9330
  • Fax: 501-207-8640
Mailing address:
  • Phone: 501-773-9330
  • Fax: 501-207-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1904045
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: