MEDICARE: LACEY HEINZELMAN LPC, LMFT

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	101YM0800X	Mental Health Counselor	10812746-6004	UT
2	106H00000X	Marriage & Family Therapist	10812746-3902	UT

General Provider Information

NPI Number	:	1093192551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY HEINZELMAN LPC, LMFT

Provider Business Mailing Address
First Line	:	228 S 100 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 S 100 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3222
Country	:	US
Telephone Number	:	906-361-9557
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	01/31/2025

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