Individual
SUMMER TEANN LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N SIDNEY AVE, RUSSELLVILLE, AR 72801-4383
(479) 890-5494
Mailing address
301 N SIDNEY AVE, RUSSELLVILLE, AR 72801-4383
(479) 890-5494
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/19/2023
Last updated
12/09/2024
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