Provider Demographics
NPI:1437696309
Name:COPE, LACEY (SUDP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:COPE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LILA LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3320
Mailing Address - Country:US
Mailing Address - Phone:360-757-7738
Mailing Address - Fax:360-757-7749
Practice Address - Street 1:201 LILA LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3320
Practice Address - Country:US
Practice Address - Phone:360-757-7738
Practice Address - Fax:360-757-7749
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60562339101YA0400X
WACP60884225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)