Healthcare Provider Details

I. General information

NPI: 1548837180
Provider Name (Legal Business Name): ASHLEY LACY LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 183RD STREET CT E
PUYALLUP WA
98375-6312
US

IV. Provider business mailing address

9702 183RD STREET CT E
PUYALLUP WA
98375-6312
US

V. Phone/Fax

Practice location:
  • Phone: 253-904-6038
  • Fax: 253-409-2622
Mailing address:
  • Phone: 253-904-6038
  • Fax: 253-409-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMG61266227
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: