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General NPI Number Information
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NPI Number | 1740790856
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Entity Type | Individual
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Provider Name | SCOTT LACY LPC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 77 CALLE PORTAL STE C240
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2986
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Country | US
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Telephone | 520-515-8669
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Fax | 520-515-8688
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Provider Business Mailing Address
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Address Line | 1205 N F AVE
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City | DOUGLAS
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State | AZ
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Zip | 85607-1920
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Country | US
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Telephone | 520-364-1429
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Fax | 520-515-8690
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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 | A1807098
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A1807098
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-23305
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License Number State | AZ
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