Provider Demographics
NPI:1821865221
Name:EMILY LACY PROFESSIONAL COUNSELING LLC
Entity Type:Organization
Organization Name:EMILY LACY PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-674-2080
Mailing Address - Street 1:2335 GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9557
Mailing Address - Country:US
Mailing Address - Phone:304-674-2080
Mailing Address - Fax:
Practice Address - Street 1:8567 S MASON MONTGOMERY RD STE 34
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9805
Practice Address - Country:US
Practice Address - Phone:304-674-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty