Provider Demographics
NPI:1750608071
Name:DYKE, LACY G (MMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:LACY
Middle Name:G
Last Name:DYKE
Suffix:
Gender:F
Credentials:MMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78646-0223
Mailing Address - Country:US
Mailing Address - Phone:512-912-6609
Mailing Address - Fax:
Practice Address - Street 1:1001 CYPRESS CREEK RD STE 301
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4469
Practice Address - Country:US
Practice Address - Phone:512-912-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63364101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211269001Medicaid
TX1912224239OtherNPI
TX211269001Medicaid