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Individual

MISS LACEY MARIE WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, LPC

Contact information

Practice address
304 E JACKSON ST STE 3B, WILLARD, MO 65781-9472
(417) 693-0120
(417) 222-3367
Mailing address
105 PEBBLE CREEK LN, WILLARD, MO 65781-8152
(417) 693-0120
(417) 222-3367

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2014042626
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1740681394
MO
Enumeration date
09/12/2014
Last updated
05/21/2025
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