Healthcare Provider Details

I. General information

NPI: 1770816217
Provider Name (Legal Business Name): LAUREN MACKENZIE VESELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 E. ARLINGTON BLVD. HEALTHY LIFESTYLES
ADA OK
74820
US

IV. Provider business mailing address

RESOURCE MANAGEMENT 1300 HOPPE BLVD., SUITE 1
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-6345
  • Fax: 580-421-7724
Mailing address:
  • Phone: 580-436-7211
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: