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General NPI Number Information
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NPI Number | 1407717259
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Entity Type | Organization
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Legal Business Name | CELESTE LACY LICENSE CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 2019 W 98TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-4002
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Country | US
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Telephone | 213-610-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 W 98TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-4002
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Country | US
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Telephone | 213-610-1024
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | CELESTE LACY
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Credential | LCSW
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Telephone | 213-610-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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