MEDICARE: LACEY TRENT LCSW

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
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	LCSW91292	CA
4	104100000X	Social Worker	6801109377	MI

General Provider Information

NPI Number	:	1538593322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY TRENT LCSW

Provider Business Mailing Address
First Line	:	13112 HADLEY ST STE 106A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4583
Country	:	US
Telephone Number	:	562-652-9744
Fax Number	:

Provider Business Practice Location Address
First Line	:	37400 GARFIELD RD STE 110
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3648
Country	:	US
Telephone Number	:	562-652-9744
Fax Number	:

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

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	04/20/2025

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