Provider Demographics
NPI:1487371134
Name:BARSHAW, LACEY K
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:K
Last Name:BARSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:K
Other - Last Name:RHOADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 GLEN CREEK RD NW STE 330
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3157
Mailing Address - Country:US
Mailing Address - Phone:503-967-5402
Mailing Address - Fax:
Practice Address - Street 1:525 GLEN CREEK RD NW STE 330
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3157
Practice Address - Country:US
Practice Address - Phone:503-967-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health