Provider Demographics
NPI:1013374057
Name:LACEY PETERS
Entity Type:Organization
Organization Name:LACEY PETERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-451-7171
Mailing Address - Street 1:PO BOX 22552
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93121-2552
Mailing Address - Country:US
Mailing Address - Phone:805-451-7171
Mailing Address - Fax:
Practice Address - Street 1:5276 HOLLISTER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2073
Practice Address - Country:US
Practice Address - Phone:805-451-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT77995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT77995OtherBOARD OF BEHAVIORAL SCIENCES LICENSE NUMBER