Provider Demographics
NPI:1538437652
Name:LAZOS, LUCILA
Entity type:Individual
Prefix:MISS
First Name:LUCILA
Middle Name:
Last Name:LAZOS
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 1:2601 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-9530
Mailing Address - Country:US
Mailing Address - Phone:405-326-0630
Mailing Address - Fax:
Practice Address - Street 1:500 N MERIDIAN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5700
Practice Address - Country:US
Practice Address - Phone:405-601-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor