Individual
MRS. LACEY NICOLE BEVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
850 E CENTER ST SUITE F, POCATELLO, ID 83201-5737
(208) 637-9940
Mailing address
1792 E PRICE RD, MCCAMMON, ID 83250-1610
(208) 637-9940
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1967
ID
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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