Provider Demographics
NPI:1982842878
Name:SCARBOROUGH, LACY BREANNE (MSED, LPC)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:BREANNE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 LAKELAND CIR STE B
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2900
Mailing Address - Country:US
Mailing Address - Phone:254-401-5781
Mailing Address - Fax:254-822-6162
Practice Address - Street 1:5002 LAKELAND CIR STE B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2900
Practice Address - Country:US
Practice Address - Phone:254-401-5781
Practice Address - Fax:254-822-6162
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional