| Doctor Name: | CLERICE LACY |
| NPI Number: | 1770937716 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS,MA,MHP,PLPC |
| License Number: | |
| Business Practice Address: | 1312 Maryland Ave Port Allen, LA - 707672232 |
| Business Phone Number: | 2253621692 |
| Business Fax Number: | |
| Mailing Address: | 1312 Maryland Ave, PORT ALLEN |
| State: | LA |
| Postal Code: | 707672232 |
| Phone Number: | 2253621692 |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2016 |
| NPI Last Update Date: | 04/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |