Individual
LISA J LACOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I, QMHA
Contact information
Practice address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Mailing address
2545 N ELDORADO AVE, KLAMATH FALLS, OR 97601-6423
(541) 883-3471
(541) 883-3524
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114058898
—
OR
05
—
1720105489
—
OR
Enumeration date
03/01/2013
Last updated
03/01/2013
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