Provider Demographics
NPI:1730501495
Name:HIGHTOWER, LAMANUEL
Entity type:Individual
Prefix:
First Name:LAMANUEL
Middle Name:
Last Name:HIGHTOWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 LAKEPINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8940
Mailing Address - Country:US
Mailing Address - Phone:615-692-9411
Mailing Address - Fax:
Practice Address - Street 1:4648 SE SALVATORI RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8271
Practice Address - Country:US
Practice Address - Phone:772-210-4362
Practice Address - Fax:772-510-5780
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
FLIMH25041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker