Provider Demographics
NPI:1407482110
Name:MERRELL, LACI LEE (MAC, LPC)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:LEE
Last Name:MERRELL
Suffix:
Gender:F
Credentials:MAC, LPC
Other - Prefix:
Other - First Name:LACI
Other - Middle Name:LEE
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAC, LPC
Mailing Address - Street 1:2028 S AUSTIN ST APT 704
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1959
Mailing Address - Country:US
Mailing Address - Phone:806-683-3949
Mailing Address - Fax:806-426-3523
Practice Address - Street 1:2028 S AUSTIN ST APT 704
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1959
Practice Address - Country:US
Practice Address - Phone:806-683-3949
Practice Address - Fax:806-426-3523
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional