Individual
LACY PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1965 LIVE OAK BLVD, YUBA CITY, CA 95991-8850
(530) 822-7200
Mailing address
1965 LIVE OAK BLVD, YUBA CITY, CA 95991-8850
(530) 822-7200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
167G00000X
Licensed Psychiatric Technician
41444
CA
167G00000X
Licensed Psychiatric Technician
Primary
—
—
Other
Enumeration date
02/15/2017
Last updated
08/14/2025
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