MEDICARE: MRS. LACY ANN BROWN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		CO

General Provider Information

NPI Number	:	1528609047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACY ANN BROWN LPC

Provider Business Mailing Address
First Line	:	PO BOX 1614
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-1614
Country	:	US
Telephone Number	:	970-507-0861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 CORNERSTONE DR STE 207
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-8156
Country	:	US
Telephone Number	:	970-507-0861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2019
Last Update Date	:	10/06/2019

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