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Individual

DR. MICHAEL LACY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD,, LBP, NCSP

Contact information

Practice address
2000 E 15TH ST STE 150C, EDMOND, OK 73013-6679
(405) 919-2147
Mailing address
PO BOX 31331, EDMOND, OK 73003-0023
(405) 285-1501
(405) 285-5210

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0238
OK
103TS0200X
School Psychologist
22098
OK

Other

Enumeration date
08/05/2007
Last updated
08/05/2007
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