Provider Demographics
NPI:1417273483
Name:BORENGASSER, LACY ANNE (LPC CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:LACY
Middle Name:ANNE
Last Name:BORENGASSER
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W MAIN
Mailing Address - Street 2:PENNINGTON CREEKLIFEHOUSE
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1243
Mailing Address - Country:US
Mailing Address - Phone:580-371-3799
Mailing Address - Fax:158-037-1255
Practice Address - Street 1:705 W MAIN
Practice Address - Street 2:PENNINGTON CREEK LIFEHOUSE
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460
Practice Address - Country:US
Practice Address - Phone:580-371-3799
Practice Address - Fax:580-371-2556
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health