Healthcare Provider Details

I. General information

NPI: 1609771724
Provider Name (Legal Business Name): LACEY CRUSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 12TH ST
NEWTON KS
67114-2356
US

IV. Provider business mailing address

415 W 41ST ST N
WICHITA KS
67204-3205
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-7829
  • Fax: 316-283-6830
Mailing address:
  • Phone: 316-558-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05599
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: