Individual
LACEY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED. PLPC
Contact information
Practice address
2726 S CLARK ST, MEXICO, MO 65265-3803
(573) 253-6939
Mailing address
1215 PLUM ST, MEXICO, MO 65265-3366
(573) 253-0443
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2011039351
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
MO
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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