Provider Demographics
NPI:1912524711
Name:FIVECOAT, LACEY DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:DAWN
Last Name:FIVECOAT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MEADOWLARK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2835
Mailing Address - Country:US
Mailing Address - Phone:870-819-6522
Mailing Address - Fax:
Practice Address - Street 1:2629 REDWING RD STE 280
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2879
Practice Address - Country:US
Practice Address - Phone:970-788-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099310831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical