LACY MICHELLE THEOBALD (NPI# 1669965687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669965687 |
| Entity Type | Individual |
| Full Name | LACY MICHELLE THEOBALD |
| Credential | LCSW |
| Practice Address |
3010 Scott Blvd Ste 103 Temple TX 76504-6803 |
| Mailing Address |
1216 Thistle Park Robinson TX 76706-7291 |
| Practice Telephone | 2547734022 |
| Practice Fax Number | 2547730919 |
| Mailing Telephone | 2548558297 |
| Mailing Fax Number | 2547730919 |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
50725 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | STATE (TX) LICENSE # FOR LCSW | 50725 | 01 |
| Street Address |
3010 SCOTT BLVD STE 103 |
| City | TEMPLE |
| State | TX |
| Zip Code | 76504-6803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265443147 | Michelle Farrell | Counselor | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2006-08-10 |
| 1306462361 | Jeffrey Jared Chupik | Counselor | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2020-06-24 |
| 1043677735 | Jason Duckworth | Marriage & Family Therapist | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2016-01-26 |
| 1912349945 | Vanessa K Brandt | Counselor | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2013-07-18 |
| 1295086460 | Rebekah Mina Oakley | Psychologist | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2012-09-27 |
| 1730459488 | Ilse Michelle Brindley | Counselor | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2012-01-11 |
| 1548551021 | Chupik Counseling & Consulting Pa | Behavioral Analyst | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2011-05-02 |
| 1033351523 | Susan Hutchinson | Social Worker | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2009-03-30 |
| 1275671174 | Eugenia Rinaldi | Counselor | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2007-02-02 |
| 1902962228 | Thomas Edward Kershaw | Social Worker | 3010 Scott Blvd Ste 103, Temple, TX 76504-6803 | 2006-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194243717 | Courtenay A Eddins | Occupational Therapy Assistant | 2010 Sw H K Dodgen Loop #201, Temple, TX 76504 | 2017-09-04 |
| 1891213500 | Melody Woods | Physical Therapy Assistant | 2010 Sw Hk Dodgen Loop, Suite 201, Temple, TX 76504 | 2017-09-01 |
| 1194255992 | Elizabeth Ford | Radiology | 202 Woodbridge Blvd 247, Temple, TX 76504 | 2017-06-14 |
| 1790223055 | Dinella Quinones | Specialist/Technologist | 2010 Sw Hkdodgen Loop, Suite 201, Temple, TX 76504 | 2017-02-07 |
| 1194277400 | Trina Morton | Specialist | 5297 S 31st Suite117a, Temple, TX 76504 | 2016-11-03 |
| 1134570922 | Plains Er Management Temple Ltd | Clinic/Center | 1551 W. Central Ave, Temple, TX 76504 | 2016-06-23 |
| 1962853770 | Express Er Temple, P.a. | Emergency Medicine | 1551 W. Central Avenue, Temple, TX 76504 | 2016-06-23 |
| 1306262548 | Nancy Lynne Sykes | Counselor | 2027 S 61st St Ste 121, Temple, TX 76504 | 2014-03-12 |
| 1972930683 | Taneka L Patrick | Social Worker | 2820 W Avenue O Ste B, Temple, TX 76504 | 2013-09-27 |
| 1255645990 | Mary Jane Ireland | Nurse Practitioner | 1901 Veterans Memorial Blvd, Temple, TX 76504 | 2010-08-05 |
| Find all providers in zip 76504 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578189635 | Paul Harvey | Counselor | 712 Brazos Dr, Temple, TX 76504-4923 | 2020-06-24 |
| 1194375022 | Stephanie Morataya | Counselor | 4008 7th Ave, Temple, PA 19560-1910 | 2019-09-12 |
| 1760911127 | Willie Marvin Hutchinson | Counselor | 1017 Highview Court, Temple, PA 19560 | 2017-06-08 |
| 1508295742 | Stephanie Diane Lalouette | Counselor | 100 W Adams Ave Ste 306, Temple, TX 76501-7647 | 2013-11-07 |
| 1356779706 | The Shepherds New Pathways, LLC | Counselor | 5293 S 31st St Ste 137, Temple, TX 76502-3575 | 2013-10-22 |
| 1487906665 | Michael David Potter | Counselor | 3513 Sw H K Dodgen Loop, Suite Number 106, Temple, TX 76502-8009 | 2012-10-11 |
| 1346512142 | Misti Dawn Wetzel | Counselor | 2010 Sw H K Dodgen Loop Ste 211, Temple, TX 76504-7057 | 2012-02-08 |
| 1750608014 | Kristy Dawn Drummond | Counselor | 305 Carrollton St, Temple, GA 30179-3796 | 2010-04-27 |
| 1700049962 | Cotina Houston Stroud | Counselor | 805 Windy Mill Ct, Temple, GA 30179-5437 | 2008-07-08 |
| 1437325529 | Amy Eileen Casey | Counselor | Scott & White Mental Health Clinic, 2401 South 31st Street, Temple, TX 76508-0001 | 2008-05-07 |
| Find all providers in TEMPLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.