Provider Demographics
NPI:1376385187
Name:LAKKIS, JESSICA (TLLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAKKIS
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 PARKLANE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2122
Mailing Address - Country:US
Mailing Address - Phone:313-207-1758
Mailing Address - Fax:
Practice Address - Street 1:16303 PARKLANE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2122
Practice Address - Country:US
Practice Address - Phone:313-207-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist