Provider Demographics
NPI:1235316647
Name:RAYMOND, LACEY JO (LCSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:JO
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59703-0215
Mailing Address - Country:US
Mailing Address - Phone:406-200-8115
Mailing Address - Fax:
Practice Address - Street 1:65 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9305
Practice Address - Country:US
Practice Address - Phone:406-200-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057875104100000X
MTBBH-LCSW-LIC-10031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker