Provider Demographics
NPI:1154816783
Name:POSSELT, LACY J (BS, MS, LPC, LMFT-IT)
Entity type:Individual
Prefix:MS
First Name:LACY
Middle Name:J
Last Name:POSSELT
Suffix:
Gender:F
Credentials:BS, MS, LPC, LMFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3124
Mailing Address - Country:US
Mailing Address - Phone:608-371-7313
Mailing Address - Fax:608-716-3138
Practice Address - Street 1:20 E MILWAUKEE ST STE 308
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3061
Practice Address - Country:US
Practice Address - Phone:608-371-7313
Practice Address - Fax:608-716-3138
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18441-130101YA0400X
WI7846-125101YM0800X, 101YP2500X
WI3919-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health