Provider Demographics
NPI:1659040657
Name:NORTHAM, LACI (LCSW)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:
Last Name:NORTHAM
Suffix:
Gender:F
Credentials: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 747
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0014
Mailing Address - Country:US
Mailing Address - Phone:972-524-4159
Mailing Address - Fax:972-524-1002
Practice Address - Street 1:395 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4253
Practice Address - Country:US
Practice Address - Phone:903-737-2475
Practice Address - Fax:903-737-2479
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical