Provider Demographics
NPI:1043470578
Name:LACY, MARGARET MARY
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4851
Mailing Address - Country:US
Mailing Address - Phone:206-769-2022
Mailing Address - Fax:
Practice Address - Street 1:15210 10TH AVE SW
Practice Address - Street 2:REN WELLNESS CENTER
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2107
Practice Address - Country:US
Practice Address - Phone:206-769-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60215190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health