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Ethan Kent Lacey
Mental Health Counselor in Wheaton, Illinois
NPI 1881302479

Ethan Kent Lacey is a Mental Health Counselor based in Wheaton, IL and is specialized in Mental Health. Ethan Kent Lacey practices in Wheaton, IL. The NPI Number for Ethan Kent Lacey is 1881302479 and holds a License No. (Illinois).

The current practice location address for Ethan Kent Lacey is 1616 E Roosevelt Rd Ste 8, Wheaton, IL and can be reached out via phone at 630-588-1201.

Location: 1616 E Roosevelt Rd Ste 8, Wheaton, IL, 60187-6850
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1881302479
Provider Name
Ethan Kent Lacey
Credential
Provider Entity Type
Individual
Gender
Male
Address
1616 E Roosevelt Rd Ste 8, Wheaton, IL, 60187-6850
Phone Number
630-588-1201
Fax Number
Provider Enumeration Date
11/11/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1616 E Roosevelt Rd Ste 8
City
Wheaton
State
Illinois
Zip
60187-6850
Phone Number
630-588-1201
Fax Number
person
Provider Business Mailing Address Details
Address
1616 E Roosevelt Rd Ste 8
City
Wheaton
State
Illinois
Zip
60187-6850
Phone Number
630-588-1201
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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