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1891020160
LACEY DAWN FULLER
MCALESTER, OK
NPI
1891020160
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2009-10-05
Last Update Date
2009-10-05
Business Address
-- LACEY DAWN FULLER BA
628 E CREEK AVE
MCALESTER, OK 74501-6930
Phone number: 918-421-3500
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Mailing Address
-- LACEY DAWN FULLER BA
PO BOX 1404
MCALESTER, OK 74502-1404
Phone number: 918-421-3500
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