| Doctor Name: | MRS. KIMBERLY GAY LACY |
| NPI Number: | 1215248877 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. L.M.H.C.A. |
| License Number: | MC 60117580 |
| Business Practice Address: | 9450 Ethan Wade Way Se Snoqualmie, WA - 980659520 |
| Business Phone Number: | 4258312100 |
| Business Fax Number: | 4258312112 |
| Mailing Address: | Po Box 969, SNOQUALMIE |
| State: | WA |
| Postal Code: | 980650969 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2010 |
| NPI Last Update Date: | 06/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MC 60117580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |