Individual
LACEY ROOF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
641 S MAIN ST, LEITCHFIELD, KY 42754-1056
(270) 899-0424
(270) 721-6628
Mailing address
641 SOUTH MAIN STREET, LEITCHFIELD, KY 42754-6122
(270) 899-0424
(270) 721-6628
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
282840
KY
Other
Enumeration date
07/20/2016
Last updated
02/09/2024
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