Healthcare Provider Details

I. General information

NPI: 1104130228
Provider Name (Legal Business Name): DENEISA STARLENE MCKASKLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 RICHARDSON DR
ODESSA TX
79762-4777
US

IV. Provider business mailing address

5120 RICHARDSON DR
ODESSA TX
79762-4777
US

V. Phone/Fax

Practice location:
  • Phone: 432-248-6449
  • Fax:
Mailing address:
  • Phone: 432-248-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: