Individual
LAKENYA TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCMHT
Contact information
Practice address
116 JE JOHNSON RD, PRENTISS, MS 39474-3104
(601) 792-4872
(601) 792-2643
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6380
MS
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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