MEDICARE: MRS. DEMEISHA RICHE LOLLIS MS, LPC-ASS., LCDC

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	101YM0800X	Mental Health Counselor	101025	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16783	TX

General Provider Information

NPI Number	:	1295343655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEMEISHA RICHE LOLLIS MS, LPC-ASS., LCDC

Provider Business Mailing Address
First Line	:	PO BOX 146
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76101-0146
Country	:	US
Telephone Number	:	945-536-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 ALPINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-4748
Country	:	US
Telephone Number	:	945-536-8083
Fax Number	:

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

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	05/08/2026

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