Provider Demographics
NPI:1720398704
Name:HORSMAN, LACEY (MS, MFT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HORSMAN
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W SHAW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3501
Mailing Address - Country:US
Mailing Address - Phone:559-824-8403
Mailing Address - Fax:
Practice Address - Street 1:1500 W SHAW AVE STE 400
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3501
Practice Address - Country:US
Practice Address - Phone:559-824-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist