MEDICARE: MS. LACY J POSSELT BS, MS, LPC, LMFT-IT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	18441-130	WI
2	101YM0800X	Mental Health Counselor	7846-125	WI
3	101YP2500X	Professional Counselor	3919-226	WI
4	101YP2500X	Professional Counselor	7846-125	WI

General Provider Information

NPI Number	:	1154816783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LACY J POSSELT BS, MS, LPC, LMFT-IT

Provider Business Mailing Address
First Line	:	415 EISENHOWER AVE
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3124
Country	:	US
Telephone Number	:	608-371-7313
Fax Number	:	608-716-3138

Provider Business Practice Location Address
First Line	:	20 E MILWAUKEE ST STE 308
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3061
Country	:	US
Telephone Number	:	608-371-7313
Fax Number	:	608-716-3138

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	02/17/2022

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