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General NPI Number Information
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NPI Number | 1609493329
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Entity Type | Organization
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Legal Business Name | LACY M. SUBY, PLLC
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2300 LIBRARY CIR
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City | GRAND FORKS
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State | ND
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Zip | 58201-6328
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Country | US
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Telephone | 17-570-4777
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Fax | 1-772-1763
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Provider Business Mailing Address
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Address Line | 2300 LIBRARY CIR
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City | GRAND FORKS
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State | ND
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Zip | 58201-6328
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Country | US
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Telephone | 701-757-0477
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Fax | 701-772-1763
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Authorized Official
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Title or Position | OWNER
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Name | LACY SUBY
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Credential |
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Telephone | 701-330-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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