MEDICARE: LACEY EVELYN NIEMI MA, LMHCA

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	101Y00000X	Counselor	MC61555987	WA

General Provider Information

NPI Number	:	1700422714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY EVELYN NIEMI MA, LMHCA

Provider Business Mailing Address
First Line	:	260 SHUMWAY RD
Second Line	:
City	:	CAMANO ISLAND
State	:	WA
Zip	:	98282-8763
Country	:	US
Telephone Number	:	360-420-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N OLYMPIC AVE STE 203
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1351
Country	:	US
Telephone Number	:	425-931-8533
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	01/01/2025

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