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General NPI Number Information
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NPI Number | 1699273649
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Entity Type | Individual
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Provider Name | JENNIFER DIANNE LACY LPC-A
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1705 S FORT HOOD ST STE 103B
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City | KILLEEN
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State | TX
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Zip | 76542-1681
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Country | US
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Telephone | 254-239-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 2452 MUSCOVY DR
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City | COPPERAS COVE
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State | TX
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Zip | 76522-9736
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Country | US
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Telephone | 850-259-0269
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1848404
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License Number State | FL
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