MEDICARE: DR. LORALYN FAITH LACEY PH.D. LMHC,LCPC,NCC

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	14571LPC	TX
2	101YM0800X	Mental Health Counselor	LH60428833	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144333832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORALYN FAITH LACEY PH.D. LMHC,LCPC,NCC

Provider Business Mailing Address
First Line	:	PO BOX 323
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-0323
Country	:	US
Telephone Number	:	509-589-1678
Fax Number	:	509-447-5310

Provider Business Practice Location Address
First Line	:	414 W 3RD ST
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-9077
Country	:	US
Telephone Number	:	509-589-1678
Fax Number	:	509-447-5310

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/26/2016

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