Individual
MS. LACY ANNE BORENGASSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC CANDIDATE
Contact information
Practice address
705 W MAIN, PENNINGTON CREEK LIFEHOUSE, TISHOMINGO, OK 73460
(580) 371-3799
(580) 371-2556
Mailing address
705 W MAIN, PENNINGTON CREEKLIFEHOUSE, TISHOMINGO, OK 73460-1243
(580) 371-3799
(158) 037-1255
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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