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General NPI Number Information
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NPI Number | 1487089769
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Entity Type | Individual
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Provider Name | LAKESA MACE LPC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 6 E LAFAYETTE AVE
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City | COALGATE
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State | OK
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Zip | 74538-2676
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Country | US
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Telephone | 405-537-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 6 E LAFAYETTE AVE
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City | COALGATE
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State | OK
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Zip | 74538-2676
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Country | US
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Telephone | 405-537-4110
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 11610
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License Number State | OK
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