Provider Demographics
NPI:1508640095
Name:FLEEMAN, LACEY (PLMHP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:FLEEMAN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W RAILWAY ST STE A102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3180
Mailing Address - Country:US
Mailing Address - Phone:308-637-1342
Mailing Address - Fax:308-365-6848
Practice Address - Street 1:115 W RAILWAY ST STE A102
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3180
Practice Address - Country:US
Practice Address - Phone:308-637-1342
Practice Address - Fax:308-365-6848
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health