Provider Demographics
NPI:1477250330
Name:BOOKSPAN, LACEY SIMONE (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:SIMONE
Last Name:BOOKSPAN
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25903
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0903
Mailing Address - Country:US
Mailing Address - Phone:424-272-0969
Mailing Address - Fax:
Practice Address - Street 1:9696 CULVER BLVD STE 303
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2759
Practice Address - Country:US
Practice Address - Phone:424-235-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT133844106H00000X
CAAPCC11978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist