Provider Demographics
NPI:1508370321
Name:TAYLOR, LACEY (PLMHP, PMSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PLMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:NE
Mailing Address - Zip Code:68031-3022
Mailing Address - Country:US
Mailing Address - Phone:402-278-0264
Mailing Address - Fax:
Practice Address - Street 1:10846 OLD MILL RD STE 5
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2655
Practice Address - Country:US
Practice Address - Phone:402-871-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72021041C0700X
NE11336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11336OtherNOT AN INSURANCE PROVIDER AT THIS TIME