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General NPI Number Information
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NPI Number | 1558939538
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Entity Type | Individual
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Provider Name | LACEY LEEANN KELLEY M. ED
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 7600 NE 41ST ST STE 200
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City | VANCOUVER
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State | WA
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Zip | 98662-6772
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Country | US
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Telephone | 360-217-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 5264 NE 121ST AVE APT M106
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City | VANCOUVER
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State | WA
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Zip | 98682-2157
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Country | US
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Telephone | 360-261-1419
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC.LH.61479922
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License Number State | WA
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