Healthcare Provider Details

I. General information

NPI: 1497511521
Provider Name (Legal Business Name): LACY HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 LILAC DR
EDMOND OK
73034-7285
US

IV. Provider business mailing address

5925 GRANDBY RD
EDMOND OK
73034-1700
US

V. Phone/Fax

Practice location:
  • Phone: 405-714-2600
  • Fax:
Mailing address:
  • Phone: 405-714-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11006
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: