Individual
LACY WILKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1015 FM 272, CELESTE, TX 75423-6248
(615) 208-0663
Mailing address
1015 FM 272, CELESTE, TX 75423-6248
(615) 208-0663
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Enumeration date
05/24/2024
Last updated
05/24/2024
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