Provider Demographics
NPI:1497900120
Name:ALLEN, LACEY (RASAC I)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RASAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3039
Mailing Address - Country:US
Mailing Address - Phone:573-888-1844
Mailing Address - Fax:573-888-6958
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3039
Practice Address - Country:US
Practice Address - Phone:573-888-1844
Practice Address - Fax:573-888-6958
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)