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NPI Code Detail

MEDICARE: LACEY CARSON

MEDICARE: LACEY CARSON
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1639603988
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY CARSON
Provider Business Mailing Address
First Line : 1309 W MISSION BLVD UNIT 9
Second Line :
City : ONTARIO
State : CA
Zip : 91762-6842
Country : US
Telephone Number : 626-541-1728
Fax Number :
Provider Business Practice Location Address
First Line : 650 S INDIAN HILL BLVD
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-5444
Country : US
Telephone Number : 909-399-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2017
Last Update Date : 07/18/2025

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Directions to “ LACEY CARSON ” Practice Location

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