Provider Demographics
NPI:1295049328
Name:SMALLEY, LACY TENAY-RYBURN
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:TENAY-RYBURN
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LACY
Other - Middle Name:TENAY-RYBURN
Other - Last Name:SMALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2730 SHADELANDS DR BLDG 10
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2820 SHADELANDS DR STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2525
Practice Address - Country:US
Practice Address - Phone:925-266-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical