| Innovative Community Resource Specialist | |
|
3535 Nw 58th St Ste 870e Oklahoma City OK 73112-4804 | |
| (405) 205-8346 | |
| Not Available |
| Full Name | Innovative Community Resource Specialist |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3535 Nw 58th St Ste 870e, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Leesa Lacey (PRESIDENT) |
| Authorized Official Contact | 4057029032 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Community Resource Specialist 3535 Nw 58th St Ste 870e Oklahoma City OK 73112-4804 Ph: (405) 702-9032 | Innovative Community Resource Specialist 3535 Nw 58th St Ste 870e Oklahoma City OK 73112-4804 Ph: (405) 205-8346 |
| NPI Number | 1003121724 |
|---|---|
| Provider Enumeration Date | 08/18/2010 |
| Last Update Date | 12/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003121724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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