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1760072086
LACY RENEE BANUELOS
GRANTS PASS, OR
NPI
1760072086
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2021-01-20
Last Update Date
2021-01-20
Business Address
LACY RENEE BANUELOS
1545 HARBECK RD
GRANTS PASS, OR 97527-5605
Phone number: 541-476-2373
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Mailing Address
LACY RENEE BANUELOS
1215 SW G ST
GRANTS PASS, OR 97526-2544
Phone number: 541-476-2373
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