Victoria L Lacey

Individual provider Active NPI Behavior Technician · Ellington, MO

NPI 1700432259 · NPPES record last updated Aug 12, 2019

Key facts

NPI
1700432259
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
315 E Walnut St
Ellington, MO 63638-7943
Phone
(573) 663-2644
Fax
(573) 663-2646
NPI assigned
Aug 12, 2019
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

315 E Walnut St
Ellington, MO 63638-7943

Mailing address

315 E Walnut St
Ellington, MO 63638-7943
Phone (573) 663-2644

Other providers in Ellington, MO

All providers in Ellington, MO · Behavior Technician in Missouri

Sources for this page

Verify at the official NPI Registry.