Provider Demographics
NPI:1124191176
Name:LUCAS, PHILIP JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 VINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-5503
Mailing Address - Country:US
Mailing Address - Phone:805-227-4500
Mailing Address - Fax:805-227-4544
Practice Address - Street 1:1104 VINE ST STE A
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-5503
Practice Address - Country:US
Practice Address - Phone:805-227-4500
Practice Address - Fax:805-227-4544
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0599943OtherFEDERAL TAX IDENTIFICATIO