Lacy Michelle Theobald, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

50725 Issued in TX

Practice address

3010 Scott Blvd Ste 103
Temple, TX 76504-6803

Phone

(254) 773-4022

Fax

(254) 773-0919

NPI assigned

Jun 13, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Philip R. Taft Psy.D. PLLC

  • Psychologist
  • Corsicana, TX
  • NPI 1366628331

  Clinical

  Medicare reassignment NPD
• Chupik Counseling & Consulting PA

  • Specialist
  • Temple, TX
  • NPI 1548551021

  Mental Health

  NPD (past)
• Progressive Behavioral Health, PLLC

  • Mental Health Counselor
  • Friendswood, TX
  • NPI 1659567238
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1669965687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 THISTLE PARK",
            "city": "ROBINSON",
            "state": "TX",
            "postal_code": "767067291",
            "telephone_number": "254-855-8297",
            "fax_number": "254-773-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 SCOTT BLVD STE 103",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765046803",
            "telephone_number": "254-773-4022",
            "fax_number": "254-773-0919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6801 Sanger Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Waco",
            "state": "TX",
            "postal_code": "767107807",
            "country_code": "US",
            "telephone_number": "903-872-4443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "LACY",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-13",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "50725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE (TX) LICENSE # FOR LCSW",
            "identifier": "50725",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Bedding Express
• The National Medical Rentals, Inc.
• The Shepherds New Pathways, LLC
• The Therapy Couch, PLLC
• The Well-Minded Plate, LLC
• Therapeveo & Katavallo Inc.
• Therapy Lincs
• Therapyseat, PLLC
• Therapyseat, PLLC
• Fatimah Thiam

• Clinical Social Worker in Temple, TX
• Providers in Temple, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.