Provider Demographics
NPI:1871947762
Name:MATTHEWS, LAKETHA
Entity type:Individual
Prefix:
First Name:LAKETHA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 LAKE FOREST BLVD STE 607
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6201
Mailing Address - Country:US
Mailing Address - Phone:504-265-1230
Mailing Address - Fax:
Practice Address - Street 1:1844 TITA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-3383
Practice Address - Country:US
Practice Address - Phone:504-452-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator