=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972240612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAKISHA RENEE HAYES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2022
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 WOODWAY DR STE 435W
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-1875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-694-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5161 SAN FELIPE ST STE 320-5294
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-3633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-694-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 88742
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------