Individual
LARISSA LACEY-MAE SERVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5863 NW 72ND ST, KANSAS CITY, MO 64151-1483
(816) 984-8280
Mailing address
2037 W SPRINGS WAY, EXCELSIOR SPRINGS, MO 64024-9304
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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