Provider Demographics
NPI:1730502147
Name:LACY, ELIZABETH (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 RIVERVIEW DR STE 201C
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4794
Mailing Address - Country:US
Mailing Address - Phone:321-222-7333
Mailing Address - Fax:
Practice Address - Street 1:1819 RIVERVIEW DR STE 201C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4794
Practice Address - Country:US
Practice Address - Phone:321-222-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health