Provider Demographics
NPI:1205693165
Name:LACEY LEICHTNAM COUNSELING & PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:LACEY LEICHTNAM COUNSELING & PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-MH, LAC
Authorized Official - Phone:605-670-8147
Mailing Address - Street 1:7520 S GRAND ARBOR CT STE 155
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3453
Mailing Address - Country:US
Mailing Address - Phone:605-702-6511
Mailing Address - Fax:
Practice Address - Street 1:7520 S GRAND ARBOR CT STE 155
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3453
Practice Address - Country:US
Practice Address - Phone:605-702-6511
Practice Address - Fax:605-223-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty