Provider Demographics
NPI:1528438710
Name:LACEY, BRENDEL
Entity type:Individual
Prefix:MRS
First Name:BRENDEL
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 N MARTIN LUTHER KING AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-3321
Mailing Address - Country:US
Mailing Address - Phone:405-427-3200
Mailing Address - Fax:405-427-3213
Practice Address - Street 1:3017 N MARTIN LUTHER KING AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111
Practice Address - Country:US
Practice Address - Phone:405-427-3200
Practice Address - Fax:405-427-3212
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator