Basic Information
Provider Information | |||||||||
NPI: | 1851855043 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LIMBRICK | ||||||||
FirstName: | LAKITRIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 400 N ALLEN DR STE 204 | ||||||||
Address2: |   | ||||||||
City: | ALLEN | ||||||||
State: | TX | ||||||||
PostalCode: | 750132568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9722331010 | ||||||||
FaxNumber: | 2146236692 | ||||||||
Practice Location | |||||||||
Address1: | 100 ALLENTOWN PKWY STE 206 | ||||||||
Address2: |   | ||||||||
City: | ALLEN | ||||||||
State: | TX | ||||||||
PostalCode: | 750024215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9722331010 | ||||||||
FaxNumber: | 2146236692 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2019 | ||||||||
LastUpdateDate: | 09/06/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/06/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6836 | LA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 6836 | LA | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 85112 | TX | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.