Lacey Janae Witham, M.S.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

#61195 Issued in CA

Practice address

12530 10TH St.
#C
Chino, CA 91710

Phone

(626) 536-2664

NPI assigned

Mar 16, 2011

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Credentials

Master of Science

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.

• Serene Pathways Family Counseling Inc

  • Marriage & Family Therapist
  • Chino, CA
  • NPI 1174913321
  Medicare reassignment NPD
• Personalized Treatment & Intervention Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Inglewood, CA
  • NPI 1861026445
  NPD

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300233600000",
    "number": "1982903001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12530 10TH ST.",
            "address_2": "#C",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "91710",
            "telephone_number": "626-536-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12530 10TH ST.",
            "address_2": "#C",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "91710",
            "telephone_number": "626-536-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHAM",
        "first_name": "LACEY",
        "middle_name": "JANAE",
        "name_prefix": "Ms.",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-16",
        "last_updated": "2011-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "#61195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derrick D Williams
• Clarence Elwood Wilson Jr., PH.D.
• Wings of Courage Family Services Counseling & Presentations, Inc.
• James Sytuan Winn, D.O.
• Luz Marina Wise, LMFT
• Brian Wong, DPM
• Kimberly Mei Ling Wong, M.F.T.
• Mei Chong Wong, PHARM.D.
• Candis Rene Woodard
• Wu Chiropractic Inc

• Marriage & Family Therapist in Chino, CA
• Providers in Chino, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2011; 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.