Healthcare Provider Details

I. General information

NPI: 1124901350
Provider Name (Legal Business Name): LACY FAMILY MENTAL HEALTH AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S OUTER DR
DUMAS AR
71639-9510
US

IV. Provider business mailing address

499 CEDAR ST
DUMAS AR
71639-9543
US

V. Phone/Fax

Practice location:
  • Phone: 870-377-4852
  • Fax: 870-218-1765
Mailing address:
  • Phone: 870-377-4852
  • Fax: 870-218-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSIE L LACY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 870-377-4852