Individual
LACY KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
300 E 1ST ST, PORTALES, NM 88130-5914
(575) 359-1221
Mailing address
1525 S AVENUE C, PORTALES, NM 88130-6819
(575) 309-3868
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
156141
NM
101YM0800X
Mental Health Counselor
T-0151121
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/26/2007
Last updated
05/06/2013
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