Provider Demographics
NPI:1851712475
Name:AMOUS, LACRESHA
Entity Type:Individual
Prefix:
First Name:LACRESHA
Middle Name:
Last Name:AMOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 FEATHERSTONE RD
Mailing Address - Street 2:APT 465
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2105
Mailing Address - Country:US
Mailing Address - Phone:405-505-0174
Mailing Address - Fax:
Practice Address - Street 1:2609 FEATHERSTONE RD
Practice Address - Street 2:APT 465
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2105
Practice Address - Country:US
Practice Address - Phone:405-505-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor