Provider Demographics
NPI:1700371648
Name:HAMILTON, LACIE JO (LPC)
Entity Type:Individual
Prefix:MS
First Name:LACIE
Middle Name:JO
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 OAK RIDGE GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3234
Mailing Address - Country:US
Mailing Address - Phone:972-589-1019
Mailing Address - Fax:
Practice Address - Street 1:14001 BEE CAVE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7173
Practice Address - Country:US
Practice Address - Phone:512-710-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional