Healthcare Provider Details

I. General information

NPI: 1467296053
Provider Name (Legal Business Name): LASHAUNE SHERICE RECKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N BRAND BLVD STE 100
GLENDALE CA
91203-3240
US

IV. Provider business mailing address

4400 W RIVERSIDE DR # 110-329
BURBANK CA
91505-4046
US

V. Phone/Fax

Practice location:
  • Phone: 747-286-2600
  • Fax:
Mailing address:
  • Phone: 310-415-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: