Provider Demographics
NPI:1780219493
Name:FALCON, LACEY (CICI)
Entity Type:Individual
Prefix:
First Name:LACEY (CICI)
Middle Name:
Last Name:FALCON
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 1:123 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2719
Mailing Address - Country:US
Mailing Address - Phone:225-323-7401
Mailing Address - Fax:
Practice Address - Street 1:123 LEE AVE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2719
Practice Address - Country:US
Practice Address - Phone:225-323-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst