Provider Demographics
NPI:1194916312
Name:LACE, DARYL E (PLPC)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:E
Last Name:LACE
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E BURFORD ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1305
Mailing Address - Country:US
Mailing Address - Phone:417-840-3970
Mailing Address - Fax:417-859-4429
Practice Address - Street 1:104 E MADISON ST STE 8
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2135
Practice Address - Country:US
Practice Address - Phone:417-840-3970
Practice Address - Fax:417-859-4429
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional