Provider Demographics
NPI:1023532926
Name:LACKEY, JAY (LCDC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:LACKEY
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-9167
Mailing Address - Country:US
Mailing Address - Phone:1903-948-8366
Mailing Address - Fax:
Practice Address - Street 1:1500 N POST OAK RD STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-5413
Practice Address - Country:US
Practice Address - Phone:713-589-4730
Practice Address - Fax:713-589-4730
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8203101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor