Provider Demographics
NPI:1659859072
Name:VLASATY, LUCY (MA, BA, MCP)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:VLASATY
Suffix:
Gender:F
Credentials:MA, BA, MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 TALLAHASSEE BLVD UNIT 463
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-7520
Mailing Address - Country:US
Mailing Address - Phone:407-558-7294
Mailing Address - Fax:
Practice Address - Street 1:4974 PALL MALL STREET WEST
Practice Address - Street 2:TRAFALGAR VILLAGE COMMUNITY
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3475
Practice Address - Country:US
Practice Address - Phone:407-558-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health