MEDICARE: RYAN LACEY LPC

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	C.2507399	OH

General Provider Information

NPI Number	:	1336028026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LACEY LPC

Provider Business Mailing Address
First Line	:	1811 S GREEN RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4211
Country	:	US
Telephone Number	:	216-832-8974
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 S GREEN RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4211
Country	:	US
Telephone Number	:	216-832-8974
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	11/06/2025

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Directions to “ RYAN LACEY LPC” Practice Location

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