Provider Demographics
NPI:1720670631
Name:GROCE, LACEY NICHOLE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:NICHOLE
Last Name:GROCE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6299 N ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-8909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 S PARK BLVD STE 21
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8838
Practice Address - Country:US
Practice Address - Phone:317-449-2104
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-45423103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-45423OtherBCBA CERTIFICATION