Provider Demographics
NPI:1770854754
Name:HEDRICK, LACEY R (BHRS)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:R
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:BHRS
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Mailing Address - Street 1:2215 NW CACHE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5239
Mailing Address - Country:US
Mailing Address - Phone:580-351-9998
Mailing Address - Fax:580-351-9898
Practice Address - Street 1:2215 NW CACHE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5239
Practice Address - Country:US
Practice Address - Phone:580-351-9998
Practice Address - Fax:580-351-9898
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2014-03-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1007474000Medicaid