Provider Demographics
NPI:1336013002
Name:ORSAK, LACY JAYE
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:JAYE
Last Name:ORSAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:JAYE
Other - Last Name:DANNHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1519 FLORENCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1519 FLORENCE RD STE 5
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7904
Practice Address - Country:US
Practice Address - Phone:254-300-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty