Healthcare Provider Details

I. General information

NPI: 1083327738
Provider Name (Legal Business Name): LACEY J ALBIN SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16010 N DALTON RD
SPOKANE WA
99208-9758
US

IV. Provider business mailing address

841001 HUAMOA APO
APO AP
96872
US

V. Phone/Fax

Practice location:
  • Phone: 509-999-8684
  • Fax:
Mailing address:
  • Phone: 509-999-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSR-47
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT87949
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP61320392
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: