Healthcare Provider Details

I. General information

NPI: 1235546169
Provider Name (Legal Business Name): LACY MAE MENZIES MS MFT LADC, LADC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 INDUSTRIAL WAY
FALLON NV
89406-3116
US

IV. Provider business mailing address

151 INDUSTRIAL WAY
FALLON NV
89406-3116
US

V. Phone/Fax

Practice location:
  • Phone: 177-666-5126
  • Fax: 775-294-6015
Mailing address:
  • Phone: 775-666-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07200-S
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number06600-L
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4451
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: