=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023394509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LACEY MEEHAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 01/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 NE 7TH AVE STE 410
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-358-2922
-----------------------------------------------------
Fax | 360-859-4682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 820221
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98682-0005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-223-2107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LF60270965
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------