Lacey Corneliusen, Licsw, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4558 Issued in ND

Legal business name

LACEY CORNELIUSEN, LICSW, LLC

Practice address

315 Main St S
Ste 301
Minot, ND 58701-3956

Phone

(701) 838-1558

Fax

(701) 852-0402

NPI assigned

Jan 2, 2014

Organization subpart

No

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

Authorized official

Name

Lacey D Corneliusen, LICSW

Title

Therapist

Phone

(701) 838-1558

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Serenity Health Solutions Other name

Tax ID family

Lacey Corneliusen Licsw LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lacey Corneliusen, Licsw, LLC

  • Clinical Social Worker
  • Minot, ND
  • NPI 1285064246
  NPD tax ID

Locations

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1861813271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S",
            "address_2": "STE 301",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-838-1558",
            "fax_number": "701-852-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S",
            "address_2": "STE 301",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-838-1558",
            "fax_number": "701-852-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACEY CORNELIUSEN, LICSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "CORNELIUSEN",
        "authorized_official_first_name": "LACEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "701-838-1558",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "4558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19337",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Serenity Health Solutions",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Holden A Kurtz
• Kellie Kvislen, OTR/L
• Carol Jean Laber, RN
• Sabrina Laboy, LPN
• Lacey Corneliusen, Licsw, LLC
• Michelle Ladage, DPT
• Jennifer L. Ladendorf, M.S. SLP
• Lakeview Health Clinic
• Dharamjeet Lall, MD
• Kayla R Lambrecht, PT, DPT

• Clinical Social Worker in Minot, ND
• Providers in Minot, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.