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General NPI Number Information
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NPI Number | 1184926909
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Entity Type | Individual
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Provider Name | LACEY WEST MA
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 02/12/2022
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Provider Practice Location Address
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Address Line | 2215 BLUE GUM AVE
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City | MODESTO
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State | CA
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Zip | 95358-1052
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Country | US
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Telephone | 209-567-4765
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 NIAGRA ST STE 4
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City | TURLOCK
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State | CA
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Zip | 95382-1057
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Country | US
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Telephone | 209-410-2443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | D1838496
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT129482
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License Number State | CA
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