Provider Demographics
NPI:1902316862
Name:MCPHETRIDGE, LACEY CONSUELO (BCBA)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:CONSUELO
Last Name:MCPHETRIDGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4216
Mailing Address - Country:US
Mailing Address - Phone:805-644-7827
Mailing Address - Fax:805-650-1385
Practice Address - Street 1:6955 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4216
Practice Address - Country:US
Practice Address - Phone:805-644-7827
Practice Address - Fax:805-650-1385
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst