MEDICARE: LACEY STEWART LPCC

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	2790	KS
2	101YM0800X	Mental Health Counselor	0187211	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780107730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY STEWART LPCC

Provider Business Mailing Address
First Line	:	PO BOX 1126
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66505-1126
Country	:	US
Telephone Number	:	505-440-7169
Fax Number	:	888-972-1882

Provider Business Practice Location Address
First Line	:	330 POYNTZ AVE STE 272
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-8039
Country	:	US
Telephone Number	:	505-379-1270
Fax Number	:	888-972-1885

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

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	10/17/2022

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