Lacey Bagley, LMFT
Individual provider Active NPI Marriage & Family Therapist · Provo, UT
NPI 1174195697 · NPPES record last updated Jul 14, 2021
Key facts
- NPI
- 1174195697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 109718443902 (UT)
- Practice address
- 363 S 400 W
Provo, UT 84601-4342 - Phone
- (509) 521-1536
- NPI assigned
- Jul 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109718443902 | UT | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Queer Family Therapy, PLLC | Current |
Accepting new patients |
Locations
288 W Center St
Provo, UT 84601
Phone (509) 521-1536
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 109718443902 | UT | Yes |
Addresses
Primary practice location
363 S 400 W
Provo, UT 84601-4342
Mailing address
363 S 400 W
Provo, UT 84601-4342
Phone (509) 521-1536
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109718443902 | Other | UT | MARRIAGE & FAMILY THERAPIST |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lacey@celebratetherapy.org | Direct |
Other providers in Provo, UT
- Matthew Jonathan Badger
- Dominique Badura
- Nicole Baer
- Berit Maria Bagley
- Douglas K Bagley
- Dirk Bradley Bahoravitch
- Michelle Anne Bahr
- Timothy Marvin Bahr
- Wendy Bahr
- Amber Nicole Bailey
All providers in Provo, UT · Marriage & Family Therapist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.