Individual
LACEY L KINZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804
(417) 761-5000
(417) 761-5011
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2010029493
MO
101YM0800X
Mental Health Counselor
2010029493
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497116509
—
MO
Enumeration date
12/08/2011
Last updated
08/07/2019
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