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General NPI Number Information
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NPI Number | 1295117356
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Entity Type | Organization
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Legal Business Name | LACEY REIKOWSKY, LPC, LLC
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 3000 UNITED FOUNDERS BLVD STE 148
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4290
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Country | US
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Telephone | 405-401-5725
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Fax |
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Provider Business Mailing Address
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Address Line | 620 SW 24TH ST
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City | MOORE
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State | OK
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Zip | 73160-5515
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Country | US
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Telephone |
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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 | LACEY REIKOWSKY
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Credential | LPC
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Telephone | 405-401-5725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4300
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4300
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4300
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License Number State | OK
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