Provider Demographics
NPI:1861565210
Name:PRICE, LACEY K (PSYD)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:K
Last Name:PRICE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MILLPOND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1561
Mailing Address - Country:US
Mailing Address - Phone:859-428-8008
Mailing Address - Fax:859-286-6444
Practice Address - Street 1:711 MILLPOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1561
Practice Address - Country:US
Practice Address - Phone:859-428-8008
Practice Address - Fax:859-286-6444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129832103T00000X
KY19332103T00000X
103TC2200X, 103TF0200X, 103TH0004X, 103TH0100X, 103TR0400X
KY1514103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100045890Medicaid
KY7100045890Medicaid
KYK197301Medicare UPIN