Provider Demographics
NPI:1457604514
Name:MITCHELL, LACRETIA SHREE (BHRS, M ED)
Entity Type:Individual
Prefix:MRS
First Name:LACRETIA
Middle Name:SHREE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BHRS, M ED
Other - Prefix:MRS
Other - First Name:LACRETIA
Other - Middle Name:SHREE
Other - Last Name:ELLILS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2616 WHITE FOX CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6563
Mailing Address - Country:US
Mailing Address - Phone:405-223-0229
Mailing Address - Fax:
Practice Address - Street 1:1017 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7202
Practice Address - Country:US
Practice Address - Phone:405-605-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator