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General NPI Number Information
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NPI Number | 1235316647
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Entity Type | Individual
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Provider Name | LACEY JO RAYMOND LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 65 E BROADWAY ST
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City | BUTTE
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State | MT
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Zip | 59701-9305
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Country | US
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Telephone | 406-200-8115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | BUTTE
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State | MT
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Zip | 59703-0215
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Country | US
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Telephone | 406-200-8115
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | RC00057875
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-1003
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License Number State | MT
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