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NPI Code Detail

MEDICARE: LESE LACKEY LPC

MEDICARE: LESE LACKEY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC-24571AZ

General Provider Information

NPI Number : 1073937868
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESE LACKEY LPC
Provider Business Mailing Address
First Line : 24894 W DOVE RUN DR
Second Line :
City : BUCKEYE
State : AZ
Zip : 85326-1721
Country : US
Telephone Number : 623-633-1362
Fax Number :
Provider Business Practice Location Address
First Line : 20440 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-3240
Country : US
Telephone Number : 480-882-4545
Fax Number : 480-882-4545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2014
Last Update Date : 04/06/2026

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