Provider Information for 1568658557
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Mr. HORACE GRADY LACKEY III LPC
Sex: Male
NPI: 1568658557
Last Updated: 2007-09-24
Certification Date:
Certification Date:
Details
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NPI | 1568658557 | ||||||||
Enumeration Date | 2007-09-24 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 1701 RIVER RUN STE 305 FORT WORTH, TX 76107-6576 United States Phone: 817-991-9194 | Fax: | ||||||||
Primary Practice Address | 1701 RIVER RUN STE 305 FORT WORTH, TX 76107-6576 United States Phone: 817-991-9194 | Fax: | ||||||||
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