Healthcare Provider Details

I. General information

NPI: 1609052869
Provider Name (Legal Business Name): LACEY MASHINTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8671 SOUTH QUEBEC ST STE 200
HIGHLANDS RANCH CO
80130
US

IV. Provider business mailing address

P.O. BOX 400
COTOPAXI CO
81223
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 719-285-5121
  • Fax: 719-218-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number969
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: