Healthcare Provider Details

I. General information

NPI: 1285416628
Provider Name (Legal Business Name): LACEY RENEE CALLAHAN BA MS MSW, LMSW US
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S 2ND ST
MCALESTER OK
74501-5814
US

IV. Provider business mailing address

109 KERR AVE
POTEAU OK
74953-5270
US

V. Phone/Fax

Practice location:
  • Phone: 918-302-0052
  • Fax:
Mailing address:
  • Phone: 580-579-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22383
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: