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General NPI Number Information
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NPI Number | 1275132888
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Entity Type | Individual
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Provider Name | LACY BONHAM
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 3750 W MAIN ST STE AA
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City | NORMAN
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State | OK
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Zip | 73072-4645
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Country | US
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Telephone | 405-824-8378
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Fax |
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Provider Business Mailing Address
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Address Line | 3682 MERLIN CT
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City | NEWCASTLE
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State | OK
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Zip | 73065-5520
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Country | US
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Telephone | 580-458-9300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OK
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