Provider Demographics
NPI:1235445974
Name:MCFALLS, LACY COLLEEN (LMP)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:COLLEEN
Last Name:MCFALLS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 3RD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270
Mailing Address - Country:US
Mailing Address - Phone:360-651-8045
Mailing Address - Fax:360-658-5029
Practice Address - Street 1:1636 3RD ST UNIT B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5004
Practice Address - Country:US
Practice Address - Phone:360-651-8045
Practice Address - Fax:360-658-5029
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMAOOO12765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist