Healthcare Provider Details

I. General information

NPI: 1124651088
Provider Name (Legal Business Name): LACEY JENEVIEVE GRUBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

IV. Provider business mailing address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-8187
  • Fax:
Mailing address:
  • Phone: 530-877-1965
  • Fax: 530-894-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: