1609052869 NPI number — LACEY MASHINTER LCSW

Table of content: SUSAN DORSCH CLARK OTR (NPI 1881851608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609052869 NPI number — LACEY MASHINTER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASHINTER
Provider First Name:
LACEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609052869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTOPAXI
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-285-5121
Provider Business Mailing Address Fax Number:
719-218-9994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8671 SOUTH QUEBEC ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-852-6672
Provider Business Practice Location Address Fax Number:
305-891-4228
Provider Enumeration Date:
01/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  969 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99124335 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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