Provider Demographics
NPI:1629536073
Name:MATTHEWS, LACEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20801 HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:BIGELOW
Mailing Address - State:AR
Mailing Address - Zip Code:72016-8009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 S PALM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5432
Practice Address - Country:US
Practice Address - Phone:501-251-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-24P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical