Organization
INNOVATIVE COMMUNITY RESOURCE SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEESA LACEY MA, LPC (PRESIDENT)
(405) 702-9032
Entity
Organization
Contact information
Practice address
3535 NW 58TH ST STE 870E, OKLAHOMA CITY, OK 73112-4804
(405) 205-8346
Mailing address
3535 NW 58TH ST STE 870E, OKLAHOMA CITY, OK 73112-4804
(405) 702-9032
(405) 702-9031
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
08/18/2010
Last updated
12/03/2010
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