Provider Demographics
NPI:1144333832
Name:LACEY, LORALYN FAITH (PHD LMHC,LCPC,NCC)
Entity type:Individual
Prefix:DR
First Name:LORALYN
Middle Name:FAITH
Last Name:LACEY
Suffix:
Gender:F
Credentials:PHD LMHC,LCPC,NCC
Other - Prefix:DR
Other - First Name:LORALYN
Other - Middle Name:FAITH
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LMHC,LCPC,NCC
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-0323
Mailing Address - Country:US
Mailing Address - Phone:509-589-1678
Mailing Address - Fax:509-447-5310
Practice Address - Street 1:414 W 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9077
Practice Address - Country:US
Practice Address - Phone:509-589-1678
Practice Address - Fax:509-447-5310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14571LPC101YP2500X
WALH60428833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095813402Medicaid
WA2041969Medicaid