Basic Information
Provider Information
NPI: 1215467766
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: LACEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 S 48TH ST
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 727626683
CountryCode: US
TelephoneNumber: 4797255115
FaxNumber: 4797504843
Practice Location
Address1: 115 S 3RD ST
Address2:  
City: HEBER SPRINGS
State: AR
PostalCode: 725433805
CountryCode: US
TelephoneNumber: 5012060831
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2017
LastUpdateDate: 03/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X9553MARY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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