Most Relevant Information
Provider Data
| NPI Number: | 1003181355 |
| Provider Name: | LACEY MARIE ELLIOTT LPC - INTERN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 68259 |
Most Important Dates
| Enumeration Date: | 03/20/2012 |
| Last Updated: | 03/20/2012 |
Provider Practice Location
9708 SKILLMAN ST
DALLAS
TX
752435150
Practice Location Phone/Fax
| Phone: | 2148638064 |
| Fax: | 2149321977 |
Provider Mailing Location
9708 SKILLMAN ST
DALLAS
TX
752435150
Provider Mailing Phone/Fax
| Phone: | 2148638064 |
| Fax: | 2149321977 |