Most Relevant Information
Provider Data
| NPI Number: | 1003074741 |
| Provider Name: | CALEB WAYNE LACK PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103TC0700X |
| Specialty: | Psychologist |
| License Number: | 07-37P |
Most Important Dates
| Enumeration Date: | 05/29/2008 |
| Last Updated: | 03/21/2018 |
Provider Practice Location
7413 OAK AVE
EDMOND
OK
730349058
Practice Location Phone/Fax
| Phone: | 4055090959 |
| Fax: |
Provider Mailing Location
7413 OAK AVE
EDMOND
OK
730349058
Provider Mailing Phone/Fax
| Phone: | 4055090959 |
| Fax: |