Provider Demographics
NPI:1174164818
Name:COURCHAINE, LACEY (NMD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:COURCHAINE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:ROYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:1725 S CORONADO RD APT 2154
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0088
Mailing Address - Country:US
Mailing Address - Phone:480-434-1238
Mailing Address - Fax:
Practice Address - Street 1:1725 S CORONADO RD APT 2154
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0088
Practice Address - Country:US
Practice Address - Phone:480-434-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1836175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath