Provider Demographics
NPI:1114599610
Name:DYE, LACY JEAN (PLMHP)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:JEAN
Last Name:DYE
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41556 ROAD 766
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-3418
Mailing Address - Country:US
Mailing Address - Phone:308-380-3247
Mailing Address - Fax:
Practice Address - Street 1:524 9TH ST
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1917
Practice Address - Country:US
Practice Address - Phone:308-380-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health