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General NPI Number Information
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NPI Number | 1437206422
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Entity Type | Individual
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Provider Name | WILBURN H LACKEY ED.D. L.P.C. L.S.O.T
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3109 OLTON RD 105E
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City | PLAINVIEW
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State | TX
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Zip | 79072-6763
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Country | US
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Telephone | 806-293-8402
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 997
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City | PLAINVIEW
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State | TX
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Zip | 79073-0997
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Country | US
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Telephone | 806-774-3935
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Fax | 806-293-1267
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12383
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License Number State | TX
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