Provider Demographics
NPI:1366103400
Name:RALEY, LACEY HALPHEN (AMFT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:HALPHEN
Last Name:RALEY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 DOGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3105
Mailing Address - Country:US
Mailing Address - Phone:615-767-2385
Mailing Address - Fax:
Practice Address - Street 1:2815 DOGWOOD PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3105
Practice Address - Country:US
Practice Address - Phone:615-933-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist