Provider Demographics
NPI:1205619376
Name:LEACH, LACEY (LPC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 WINDSOR PARK LN
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-8717
Mailing Address - Country:US
Mailing Address - Phone:903-738-1944
Mailing Address - Fax:
Practice Address - Street 1:4503 WINDSOR PARK LN
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-8717
Practice Address - Country:US
Practice Address - Phone:903-738-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional