Provider Demographics
NPI:1134456981
Name:LUK, NICOLE RENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENE
Last Name:LUK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:RENE
Other - Last Name:HARDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:600 W SHAW AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2420
Mailing Address - Country:US
Mailing Address - Phone:559-298-2229
Mailing Address - Fax:
Practice Address - Street 1:600 W SHAW AVE STE 210
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2420
Practice Address - Country:US
Practice Address - Phone:559-298-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist