Provider Demographics
NPI:1740790856
Name:LACY, SCOTT (LPC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LACY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-515-8690
Practice Address - Street 1:77 CALLE PORTAL STE C240
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2986
Practice Address - Country:US
Practice Address - Phone:520-515-8669
Practice Address - Fax:520-515-8688
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1807098101YM0800X, 101YP2500X
171M00000X
AZLPC-23305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator