Most Relevant Information
Provider Data
| NPI Number: | 1003431362 |
| Provider Name: | JOHN LACY |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | PROFESSIONALLICENSE |
Most Important Dates
| Enumeration Date: | 06/12/2020 |
| Last Updated: | 06/05/2024 |
Provider Practice Location
17640 NE HALSEY ST
PORTLAND
OR
972306733
Practice Location Phone/Fax
| Phone: | 5034895045 |
| Fax: | 5034895638 |
Provider Mailing Location
3587 HEATHROW WAY
MEDFORD
OR
975044004
Provider Mailing Phone/Fax
| Phone: | 5418588170 |
| Fax: |