Provider Demographics
NPI:1740749134
Name:LECY THERAPY LLC
Entity Type:Organization
Organization Name:LECY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LECY
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP, QMHP
Authorized Official - Phone:801-910-3165
Mailing Address - Street 1:2218 JACKSON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3452
Mailing Address - Country:US
Mailing Address - Phone:801-910-3165
Mailing Address - Fax:605-791-0122
Practice Address - Street 1:2218 JACKSON BLVD STE 13
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3452
Practice Address - Country:US
Practice Address - Phone:801-910-3165
Practice Address - Fax:605-791-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty