MEDICARE: MS. LACEY J ALBIN SUDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CP61320392	WA
2	101YM0800X	Mental Health Counselor		WA
3	101YM0800X	Mental Health Counselor	LMFT87949	CA
4	101Y00000X	Counselor	SR-47	OR

General Provider Information

NPI Number	:	1083327738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LACEY J ALBIN SUDP

Provider Business Mailing Address
First Line	:	841001 HUAMOA
Second Line	:	APO
City	:	APO
State	:	AP
Zip	:	96872
Country	:	US
Telephone Number	:	509-999-8684
Fax Number	:

Provider Business Practice Location Address
First Line	:	16010 N DALTON RD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-9758
Country	:	US
Telephone Number	:	509-999-8684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	04/13/2026

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