Provider Demographics
NPI:1871979864
Name:TIMMS, LACEY (MS,LPC)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:TIMMS
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CIRCLE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8001
Mailing Address - Country:US
Mailing Address - Phone:570-236-1855
Mailing Address - Fax:
Practice Address - Street 1:1004 CIRCLE GREEN DR
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8001
Practice Address - Country:US
Practice Address - Phone:570-236-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional