Provider Demographics
NPI:1023394509
Name:MEEHAN, LACEY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820221
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0005
Mailing Address - Country:US
Mailing Address - Phone:808-223-2107
Mailing Address - Fax:
Practice Address - Street 1:10000 NE 7TH AVE STE 410
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4548
Practice Address - Country:US
Practice Address - Phone:360-358-2922
Practice Address - Fax:360-859-4682
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60270965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist