Provider Demographics
NPI:1053683565
Name:LUCAS, JEFF W (PHD MSW, LCPC,LMHC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:W
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PHD MSW, LCPC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MID AMERICA PLZ
Mailing Address - Street 2:SUITE 800
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4451
Mailing Address - Country:US
Mailing Address - Phone:630-916-9926
Mailing Address - Fax:630-916-9925
Practice Address - Street 1:2 MID AMERICA PLZ
Practice Address - Street 2:SUITE 800
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4451
Practice Address - Country:US
Practice Address - Phone:630-916-9926
Practice Address - Fax:630-916-9925
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11990101YP2500X
IL180000760103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85591931OtherMEMBER AMERICAN PSYCHOLOGICAL ASSOCIATION
FLMH 119990OtherLICENSED MENTAL HEALTH COUNSELOR
IL180-000760OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR