Healthcare Provider Details

I. General information

NPI: 1073937868
Provider Name (Legal Business Name): LESE LACKEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20440 N 27TH AVE
PHOENIX AZ
85027-3240
US

IV. Provider business mailing address

24894 W DOVE RUN DR
BUCKEYE AZ
85326-1721
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 480-882-4545
Mailing address:
  • Phone: 623-633-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: