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NPI Code Detail

MEDICARE: LAKENDRA NICOLE TEAL LMSW

MEDICARE:   LAKENDRA NICOLE TEAL  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
1104100000XSocial Worker104455TX

General Provider Information

NPI Number : 1952008658
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKENDRA NICOLE TEAL LMSW
Provider Business Mailing Address
First Line : 428 CENTENNIAL PKWY
Second Line :
City : TYLER
State : TX
Zip : 75703-7166
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 428 CENTENNIAL PKWY
Second Line :
City : TYLER
State : TX
Zip : 75703-7166
Country : US
Telephone Number : 903-266-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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Directions to “ LAKENDRA NICOLE TEAL LMSW” Practice Location

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