Lacy, Tequila Jantana

Lacy, Tequila Jantana is an individual health care provider with primary practice located at 2808 Fox Meadow Lane , Jonesboro AR 72404-9346. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Behavioral Health & Social Service Providers / Behavior Technician. Behavioral Health & Social Service Providers / Behavior Technician is her primary health care specialty. Lacy, Tequila Jantana can be contacted via phone (870) 932-4245.

Contact Information

Primary practice address
2808 Fox Meadow Lane Jonesboro AR 72404-9346
Phone: (870) 932-4245
Fax: (870) 931-4457
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1073187324
LBN Legal business name Lacy, Tequila Jantana
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2021
Last updated Jun 3rd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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