MEDICARE: LACI LEIGH STRUBLE LMHC

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	082709	IA

General Provider Information

NPI Number	:	1194335752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACI LEIGH STRUBLE LMHC

Provider Business Mailing Address
First Line	:	4027 70TH ST
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-2615
Country	:	US
Telephone Number	:	515-402-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 OAKLAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-3329
Country	:	US
Telephone Number	:	515-402-0877
Fax Number	:

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

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	02/04/2025

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