Provider Demographics
NPI:1770937716
Name:LACY, CLERICE (BS,MA,MHP,PLPC)
Entity type:Individual
Prefix:
First Name:CLERICE
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:BS,MA,MHP,PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2747
Mailing Address - Country:US
Mailing Address - Phone:225-362-1692
Mailing Address - Fax:
Practice Address - Street 1:1312 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2232
Practice Address - Country:US
Practice Address - Phone:225-362-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health