=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851639454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN L. LACKEY LPC-S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 01/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6901 MEDICAL CENTER DR
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77630-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-883-9940
-----------------------------------------------------
Fax | 866-883-6818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6901 MEDICAL CENTER DR
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77630-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-883-9940
-----------------------------------------------------
Fax | 866-883-6818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 11455
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 67594
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------