Provider Demographics
NPI:1801136544
Name:LACEY, ALENA MARIE (LPC-IT)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:MARIE
Last Name:LACEY
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 N SANTA MONICA BLVD
Mailing Address - Street 2:1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5122
Mailing Address - Country:US
Mailing Address - Phone:414-897-3662
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 2000
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3284
Practice Address - Country:US
Practice Address - Phone:269-270-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional