Provider Demographics
NPI:1710303797
Name:TORRES, LACEY
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 DELUCCHI LN
Mailing Address - Street 2:#207
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6578
Mailing Address - Country:US
Mailing Address - Phone:775-825-7500
Mailing Address - Fax:
Practice Address - Street 1:310 DEVERE WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2312
Practice Address - Country:US
Practice Address - Phone:775-376-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health