Individual
LACY DATTALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2512 E 71ST ST STE H, TULSA, OK 74136-5575
(918) 510-2170
Mailing address
2512 E 71ST ST STE H, TULSA, OK 74136-5575
(918) 510-2170
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
LPC06561
OK
Other
Enumeration date
10/30/2014
Last updated
11/08/2023
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