Provider Demographics
NPI:1033277637
Name:LUKES, GINA M (MFT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:LUKES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 COSTA RUSTICO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7120
Mailing Address - Country:US
Mailing Address - Phone:949-481-5553
Mailing Address - Fax:
Practice Address - Street 1:3662 KATELLA AVE STE 116
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3126
Practice Address - Country:US
Practice Address - Phone:562-431-8822
Practice Address - Fax:562-431-8875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist