Provider Demographics
NPI:1154639789
Name:BRAUN, LACIE (MA)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2808 E MADISON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2808 E MADISON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4862
Practice Address - Country:US
Practice Address - Phone:360-519-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60169897101YM0800X
WALH 60486991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health