Individual
DR. CALEB WAYNE LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
7413 OAK AVE, EDMOND, OK 73034-9058
(405) 509-0959
Mailing address
7413 OAK AVE, EDMOND, OK 73034-9058
(405) 509-0959
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
07-37P
AR
103TC0700X
Clinical Psychologist
Primary
1143
OK
Other
Enumeration date
05/29/2008
Last updated
03/21/2018
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