Provider Demographics
NPI:1639459266
Name:KEENZE, LACEY MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:MARIE
Last Name:KEENZE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44676
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70504-0001
Mailing Address - Country:US
Mailing Address - Phone:337-233-2400
Mailing Address - Fax:337-233-3656
Practice Address - Street 1:800 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4210
Practice Address - Country:US
Practice Address - Phone:337-233-2400
Practice Address - Fax:337-233-3656
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3D225Medicare UPIN