Healthcare Provider Details

I. General information

NPI: 1144796368
Provider Name (Legal Business Name): LACEY JO SCHUSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 E 20TH AVE
APACHE JUNCTION AZ
85119-9378
US

IV. Provider business mailing address

6255 E 20TH AVE
APACHE JUNCTION AZ
85119-9378
US

V. Phone/Fax

Practice location:
  • Phone: 602-904-2799
  • Fax:
Mailing address:
  • Phone: 602-904-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-16859
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC19126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: