Provider Demographics
NPI:1033795216
Name:HOUSE, LUKE P (LCPCCC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:P
Last Name:HOUSE
Suffix:
Gender:M
Credentials:LCPCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PEGASUS ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-5028
Mailing Address - Country:US
Mailing Address - Phone:207-373-0620
Mailing Address - Fax:
Practice Address - Street 1:8 TERAN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1602
Practice Address - Country:US
Practice Address - Phone:207-831-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty