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1003431362
JOHN LACY
PORTLAND, OR
NPI
1003431362
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: professionallicense)
Enumeration Date
2020-06-12
Last Update Date
2024-06-05
Business Address
JOHN LACY
17640 NE HALSEY ST
PORTLAND, OR 97230-6733
Phone number: 503-489-5045
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Mailing Address
JOHN LACY
3587 HEATHROW WAY
MEDFORD, OR 97504-4004
Phone number: 541-858-8170
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