Provider Demographics
NPI:1780107730
Name:STEWART, LACEY (LPCC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPCC
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 1126
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-1126
Mailing Address - Country:US
Mailing Address - Phone:505-440-7169
Mailing Address - Fax:888-972-1882
Practice Address - Street 1:330 POYNTZ AVE STE 272
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-8039
Practice Address - Country:US
Practice Address - Phone:505-379-1270
Practice Address - Fax:888-972-1885
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2790101YM0800X
NM0187211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201329460AMedicaid
NM47225335Medicaid