Individual
TEQUILA JANTANA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2808 FOX MEADOW LANE, JONESBORO, AR 72404-9346
(870) 932-4245
(870) 931-4457
Mailing address
2808 FOX MEADOW LANE, JONESBORO, AR 72404-9346
(870) 932-4245
(870) 931-4457
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
174400000X
Specialist
—
—
Other
Enumeration date
05/19/2021
Last updated
06/03/2024
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