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General NPI Number Information
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NPI Number | 1194059964
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Entity Type | Organization
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Legal Business Name | LACY M DEESE, LLC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 1600 N STATE ST SUITE 100
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City | JACKSON
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State | MS
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Zip | 39202-1689
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Country | US
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Telephone | 601-670-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 804 E LEAKE ST
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City | CLINTON
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State | MS
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Zip | 39056-4325
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Country | US
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Telephone | 601-670-6444
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LACY M DEESE
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Credential | LPC
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Telephone | 601-670-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1466
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License Number State | MS
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