Provider Demographics
NPI:1598374845
Name:DORMAN, LACEY R (LPC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:R
Last Name:DORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:R
Other - Last Name:CLARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC ASSOCIATE
Mailing Address - Street 1:902 OURAY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3330
Mailing Address - Country:US
Mailing Address - Phone:970-986-6295
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-549-1182
Practice Address - Fax:970-549-1400
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017388101YP2500X
CO0016585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional