Provider Demographics
NPI:1477671931
Name:LACY, MYTHEA MARIE
Entity Type:Individual
Prefix:MRS
First Name:MYTHEA
Middle Name:MARIE
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYTHEA
Other - Middle Name:
Other - Last Name:JOHNSON MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2957 SUNCATCHER CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1878
Mailing Address - Country:US
Mailing Address - Phone:907-646-7634
Mailing Address - Fax:
Practice Address - Street 1:2735 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1135
Practice Address - Country:US
Practice Address - Phone:907-562-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor