Provider Demographics
NPI:1336905470
Name:LACY, STEPHANIE TERESA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TERESA
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4012
Mailing Address - Country:US
Mailing Address - Phone:765-508-1914
Mailing Address - Fax:
Practice Address - Street 1:804 N ELGIN ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4012
Practice Address - Country:US
Practice Address - Phone:765-508-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor