Provider Demographics
NPI:1023216074
Name:LACY, AMBER A (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:A
Last Name:LACY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10649 SAINT PAUL CT
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-6118
Mailing Address - Country:US
Mailing Address - Phone:303-320-3790
Mailing Address - Fax:303-320-4290
Practice Address - Street 1:50 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5103
Practice Address - Country:US
Practice Address - Phone:303-780-9191
Practice Address - Fax:303-780-9192
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 4363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional