Provider Demographics
NPI:1902247091
Name:VAUGHAN, LACEY R (LCSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:R
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-945-4589
Mailing Address - Fax:405-945-4381
Practice Address - Street 1:3400 NW EXPRESSWAY STE 500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4492
Practice Address - Country:US
Practice Address - Phone:405-945-4589
Practice Address - Fax:405-945-4381
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor