Provider Demographics
NPI:1609493329
Name:LACY M. SUBY, PLLC
Entity Type:Organization
Organization Name:LACY M. SUBY, PLLC
Other - Org Name:LEVEL UP MENTAL HEALTH COLLABORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-330-4348
Mailing Address - Street 1:2300 LIBRARY CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6328
Mailing Address - Country:US
Mailing Address - Phone:701-757-0477
Mailing Address - Fax:701-772-1763
Practice Address - Street 1:2300 LIBRARY CIR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6328
Practice Address - Country:US
Practice Address - Phone:017-570-4777
Practice Address - Fax:001-772-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1476569Medicaid