Provider Demographics
NPI:1598374845
Name:DORMAN, LACEY R (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:R
Last Name:DORMAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:R
Other - Last Name:CLARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC ASSOCIATE
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0431
Mailing Address - Country:US
Mailing Address - Phone:970-986-6295
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 431
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-0431
Practice Address - Country:US
Practice Address - Phone:970-986-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016585101YP2500X
WY2242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional