MEDICARE: LAKELTRA JONES LMSW

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	104100000X	Social Worker	108771	TX

General Provider Information

NPI Number	:	1568154706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKELTRA JONES LMSW

Provider Business Mailing Address
First Line	:	9510 JAPONICA DR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469-2561
Country	:	US
Telephone Number	:	346-366-1263
Fax Number	:

Provider Business Practice Location Address
First Line	:	13910 CHAMPION FOREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1882
Country	:	US
Telephone Number	:	832-814-6167
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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