Provider Demographics
NPI:1104016930
Name:FISHER, LACEY NICOLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:NICOLE
Last Name:FISHER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SE FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3917
Mailing Address - Country:US
Mailing Address - Phone:918-336-4646
Mailing Address - Fax:918-336-8710
Practice Address - Street 1:622 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3917
Practice Address - Country:US
Practice Address - Phone:918-336-4646
Practice Address - Fax:918-336-8710
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)