Provider Demographics
NPI:1386363539
Name:MARTINEZ, LACIE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:LACIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:LACIE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:758 BUCKEYE CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5564
Mailing Address - Country:US
Mailing Address - Phone:270-799-1415
Mailing Address - Fax:270-715-4560
Practice Address - Street 1:758 BUCKEYE CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5564
Practice Address - Country:US
Practice Address - Phone:270-799-1415
Practice Address - Fax:270-715-4560
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY279749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health