Provider Demographics
NPI:1881189496
Name:PIZARRO, LACY KATHRYN
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:KATHRYN
Last Name:PIZARRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:KATHRYN
Other - Last Name:EKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:868 LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-8508
Mailing Address - Country:US
Mailing Address - Phone:509-964-6593
Mailing Address - Fax:
Practice Address - Street 1:227 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3611
Practice Address - Country:US
Practice Address - Phone:509-995-3388
Practice Address - Fax:509-321-4350
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
WABA61441786103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396085718Medicaid