Active NPI
Lacey Leach, LPC
- Professional Counselor
- Kilgore, TX
National Provider Identifier
1205619376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 74355
- Practice address
- 4503 Windsor Park LN
Kilgore, TX 75662-8717 - Phone
- (903) 738-1944
- NPI assigned
- Aug 14, 2023
- Last updated
- Aug 14, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 74355 | TX | Primary |
Addresses
Primary practice location
4503 Windsor Park LN
Kilgore, TX 75662-8717
Mailing address
4503 Windsor Park LN
Kilgore, TX 75662-8717
Phone (903) 738-1944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 26, 2024 through Jun 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74355 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1205619376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4503 WINDSOR PARK LN",
"city": "KILGORE",
"state": "TX",
"postal_code": "756628717",
"telephone_number": "903-738-1944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4503 WINDSOR PARK LN",
"city": "KILGORE",
"state": "TX",
"postal_code": "756628717",
"telephone_number": "903-738-1944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEACH",
"first_name": "LACEY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "74355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kilgore, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.