Lakeisha Shonta Gantt, PHD is a medicare enrolled "Psychologist - Clinical" provider in Athens, Georgia. Her current practice location is
2750 Lexington Rd, Athens, Georgia. You can reach out to her office (for appointments etc.) via phone at
(706) 389-8207.
Lakeisha Shonta Gantt is licensed to practice in Georgia (license number PSY003777) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1134495971.
Healthcare Provider's Profile
Full Name | Lakeisha Shonta Gantt |
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Gender | Female |
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Speciality | Psychologist - Clinical |
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Location | 2750 Lexington Rd, Athens, Georgia |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1134495971
- Provider Enumeration Date: 03/27/2012
- Last Update Date: 07/10/2024
Medicare PECOS Information:
- PECOS PAC ID: 2264972363
- Enrollment ID: I20240905001663
Medical Identifiers
Medical identifiers for Lakeisha Shonta Gantt such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1134495971 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YP2500X | Counselor - Professional | LPC006380 (Georgia) | Secondary |
103TC0700X | Psychologist - Clinical | PSY003777 (Georgia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lakeisha Shonta Gantt allows following entities to bill medicare on her behalf.
Entity Name | Mindsprings Counseling And Consulting Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1154185932 PECOS PAC ID: 0446790547 Enrollment ID: O20240904000813 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lakeisha Shonta Gantt is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Lakeisha Shonta Gantt, PHD 225 Swanson Dr, Athens, GA 30606-3219 Ph: (706) 389-8207 | Lakeisha Shonta Gantt, PHD 2750 Lexington Rd, Athens, GA 30605-2406 Ph: (706) 389-8207 |
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