Individual
MARY KELLY MOORE LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4013 NW EXPRESSWAY STE 105, OKLAHOMA CITY, OK 73116-2618
(405) 378-2727
Mailing address
4013 NW EXPRESSWAY STE 105, OKLAHOMA CITY, OK 73116-2618
(405) 378-2727
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC04635
OK
101YP2500X
Professional Counselor
Primary
LPC04635
OK
Other
Enumeration date
06/30/2008
Last updated
01/15/2025
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