Individual
LACY ELIZABETH MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW U/S, LMSW
Contact information
Practice address
400 E SYCAMORE ST, HOLLIS, OK 73550-1436
(580) 688-2800
Mailing address
400 E SYCAMORE ST, HOLLIS, OK 73550-1436
(580) 688-2800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5836-P
OK
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/21/2012
Last updated
03/20/2018
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