Provider Demographics
NPI:1386219517
Name:POWERS, LACEY R (BSW)
Entity Type:Individual
Prefix:MISS
First Name:LACEY
Middle Name:R
Last Name:POWERS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-1645
Mailing Address - Country:US
Mailing Address - Phone:405-331-4567
Mailing Address - Fax:
Practice Address - Street 1:1009 NORTH ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-1645
Practice Address - Country:US
Practice Address - Phone:405-331-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker