Healthcare Provider Details

I. General information

NPI: 1336019538
Provider Name (Legal Business Name): LACEY MOYER NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
EAST STROUDSBURG PA
18301-2816
US

IV. Provider business mailing address

PO BOX 288
STROUDSBURG PA
18360-0288
US

V. Phone/Fax

Practice location:
  • Phone: 570-620-4311
  • Fax: 570-620-4322
Mailing address:
  • Phone: 570-620-4311
  • Fax: 570-620-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017768
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: