Provider Demographics
NPI:1558560508
Name:LACY, CALLIE R (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:R
Last Name:LACY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2724
Mailing Address - Country:US
Mailing Address - Phone:773-221-9160
Mailing Address - Fax:773-221-9197
Practice Address - Street 1:1701 E 86TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2724
Practice Address - Country:US
Practice Address - Phone:773-221-9160
Practice Address - Fax:773-221-9197
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional