Provider Demographics
NPI:1154027589
Name:LACOY, KRYSTAL RENEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:RENEE
Last Name:LACOY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:RENEE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 FULTON ST E STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3262
Mailing Address - Country:US
Mailing Address - Phone:616-228-9244
Mailing Address - Fax:
Practice Address - Street 1:233 FULTON ST E STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3262
Practice Address - Country:US
Practice Address - Phone:616-228-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist