Provider Demographics
NPI:1558021618
Name:HERSHBERGER, LACEY
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1204
Mailing Address - Country:US
Mailing Address - Phone:574-354-2298
Mailing Address - Fax:
Practice Address - Street 1:508 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1204
Practice Address - Country:US
Practice Address - Phone:574-354-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health