Provider Demographics
NPI:1063300192
Name:ECCLES, LACY E (PCLC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:E
Last Name:ECCLES
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ARMORY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8928
Mailing Address - Country:US
Mailing Address - Phone:406-270-4312
Mailing Address - Fax:
Practice Address - Street 1:245 2ND ST W
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3006
Practice Address - Country:US
Practice Address - Phone:406-298-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-80544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health