Provider Demographics
NPI:1710273735
Name:HIBNER, LACEY (LSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HIBNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:SEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW, LCDC III
Mailing Address - Street 1:4761 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-8216
Mailing Address - Country:US
Mailing Address - Phone:419-584-1000
Mailing Address - Fax:419-584-1825
Practice Address - Street 1:401 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1736
Practice Address - Country:US
Practice Address - Phone:419-584-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.06000382104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker