Corneliusen, Lacey D

Corneliusen, Lacey D is an individual health care provider with primary practice located at 6301 19Th Ave Nw , Minot ND 58703-8899. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Corneliusen, Lacey D can be contacted via phone (701) 852-3628.

Contact Information

Primary practice address
6301 19Th Ave Nw Minot ND 58703-8899
Phone: (701) 852-3628
Fax: (701) 852-1190
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 4558 North Dakota

Profile Details

NPI number 1871819979
LBN Legal business name Corneliusen, Lacey D
Credentials LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2010
Last updated Dec 31st, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871819979 NPPES
North Dakota MEDICAID 19337
North Dakota MEDICAID 74214

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