Doctor Name: | LEESA LACEY |
NPI Number: | 1932431749 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 3535 Nw 58th St. Suite 870 Okc, OK - 73112 |
Business Phone Number: | 4057029032 |
Business Fax Number: | |
Mailing Address: | 3121 Nw 54th St, OKLAHOMA CITY |
State: | OK |
Postal Code: | 731125308 |
Phone Number: | 4052058326 |
Fax Number: | |
NPI Enumeration Date: | 02/03/2010 |
NPI Last Update Date: | 02/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |