Healthcare Provider Details

I. General information

NPI: 1861233025
Provider Name (Legal Business Name): LACEY REDDING MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22226 VILLA DR
SNOHOMISH WA
98296-4931
US

IV. Provider business mailing address

22226 VILLA DR
SNOHOMISH WA
98296-4931
US

V. Phone/Fax

Practice location:
  • Phone: 425-273-3674
  • Fax:
Mailing address:
  • Phone: 425-273-3674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61533886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: