Provider Demographics
NPI:1770227902
Name:WELLS, LACY (MSW)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-9207
Mailing Address - Country:US
Mailing Address - Phone:765-720-1700
Mailing Address - Fax:
Practice Address - Street 1:107 E WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1563
Practice Address - Country:US
Practice Address - Phone:765-246-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010192A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker