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General NPI Number Information
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NPI Number | 1659621571
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Entity Type | Individual
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Provider Name | LACY OVERLEY
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Gender | Female
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 2803 CREEK DR STE D
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City | JONESBORO
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State | AR
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Zip | 72401-5377
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Country | US
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Telephone | 870-340-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 505 OLD CANYON RD
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City | JONESBORO
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State | AR
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Zip | 72404-9406
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Country | US
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Telephone | 662-321-0728
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 408
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2408023
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License Number State | AR
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