Provider Demographics
NPI:1265665251
Name:HOLCOMB, LACEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ELIZABETH
Last Name:HOLCOMB
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 1:744 W WILLIAM CANNON DR
Mailing Address - Street 2:#2116
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3181
Mailing Address - Country:US
Mailing Address - Phone:281-639-0635
Mailing Address - Fax:
Practice Address - Street 1:1930 RAWHIDE DR
Practice Address - Street 2:302
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6953
Practice Address - Country:US
Practice Address - Phone:512-246-2232
Practice Address - Fax:512-246-8030
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional