=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093675985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. STEPHEN R LACEY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 S JONES BLVD STE 8834
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-326-3536
-----------------------------------------------------
Fax | 725-326-3536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 S JONES BLVD STE 8834
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-346-6528
-----------------------------------------------------
Fax | 725-246-7118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------